| NPI | 1700439122 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERICK QUE Manager 747-238-2544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2019-07-24 |
| Last Update Date | 2019-07-24 |