NPI | 1407375991 |
---|---|
Entity Type | Organization |
Authorized Contact | SAMUEL CLARK TRASK General Partner 843-524-2001 |
Organization Subpart ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC MD26623) |
Additional Taxonomies | 207QB0002X Family Medicine, Bariatric Medicine (Licence: SC MD26623) |
Enumeration Date | 2017-09-15 |
Last Update Date | 2022-07-21 |