| NPI | 1609201078 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADAM WINTER Billing Manager 602-577-8836 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: AZ 2830) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: AZ 2830) |
| Enumeration Date | 2013-09-04 |
| Last Update Date | 2013-10-28 |