| NPI | 1669260493 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINE MLOT Authorized Official 888-789-9585 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine |
| Enumeration Date | 2025-04-30 |
| Last Update Date | 2025-04-30 |