| NPI | 1619503026 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLIVE FIELDS Cmo 346-766-0604 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2020-03-17 |
| Last Update Date | 2023-08-22 |