| NPI | 1619606571 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KWAMANE LIDDELL CEO 708-502-2828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care |
| Enumeration Date | 2022-06-07 |
| Last Update Date | 2022-10-06 |