| NPI | 1679461727 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER ELIZEBETH KHALED Owner/Provider 531-218-4184 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Enumeration Date | 2025-06-26 |
| Last Update Date | 2025-06-26 |