| NPI | 1669701959 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | UGHANMWAN TOKUNBOR EFEOVBOKHAN Owner 210-789-1274 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 363LG0600X Nurse Practitioner, Gerontology | |
| Enumeration Date | 2009-12-15 |
| Last Update Date | 2022-03-22 |