| NPI | 1356863203 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL ALEXANDER Owner 844-735-2773 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine |
| 207R00000X Internal Medicine | |
| 207RA0401X Internal Medicine, Addiction Medicine | |
| 208D00000X General Practice | |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2019-01-11 |