| NPI | 1699370114 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHY KONDAS Officer 643-251-1132 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2020-12-02 |
| Last Update Date | 2020-12-02 |