| NPI | 1639331275 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN GOULD President 839-200-7810 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| 207Q00000X Family Medicine | |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2022-01-27 |