| NPI | 1689210197 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NIKITAS WILLIAM MILES Management Company 518-577-7506 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2019-11-19 |
| Last Update Date | 2020-09-11 |