| NPI | 1407579022 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH JOSEPH FORTIER Member Manager 919-612-1102 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology, Gynecology |
| Enumeration Date | 2022-09-20 |
| Last Update Date | 2023-05-10 |