| NPI | 1396005625 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURIE ANNE ATEN Owner 940-220-0887 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: TX J0428) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX J0428) |
| 2083P0011X Preventive Medicine Undersea and Hyperbaric Medicine (Licence: TX J0428) | |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2012-10-04 |