| NPI | 1396621983 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICK D. KAVANAGH Owner 888-696-4322 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2025-08-12 |
| Last Update Date | 2025-08-12 |