| NPI | 1619713930 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE MAXWELL Authorized Official/Owner 774-266-4793 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2024-07-05 |
| Last Update Date | 2024-07-05 |