| NPI | 1659017499 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB KIRKEENG Owner Member 928-925-2871 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| 207R00000X Internal Medicine | |
| Enumeration Date | 2022-05-05 |
| Last Update Date | 2023-03-22 |