| NPI | 1528503687 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MYLES STANDISH Representative/Agent 206-300-3992 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: AK 4823) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AK 340) |
| Enumeration Date | 2016-12-28 |
| Last Update Date | 2016-12-28 |