| NPI | 1376939330 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER M. BISHARA Resident 551-655-1657 |
| Organization Subpart ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2015-05-11 |