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 |