| NPI | 1568034775 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARQUITA JOHNIKEN Owner 302-784-5662 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207QA0505X Family Medicine, Adult Medicine | |
| 207QG0300X Family Medicine, Geriatric Medicine | |
| Enumeration Date | 2021-07-15 |
| Last Update Date | 2024-02-10 |