| NPI | 1528536471 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANNA OSEITUTU-EBANKS Owner 347-743-3773 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QB0002X Family Medicine Obesity Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2018-11-08 |
| Last Update Date | 2025-03-12 |