| NPI | 1356841100 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRAKASH PURANIK Partner/Owner 681-207-7389 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 207Q00000X Family Medicine | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2018-02-19 |
| Last Update Date | 2022-02-22 |