NPI | 1700627130 |
---|---|
Entity Type | Organization |
Authorized Contact | BRADLEY GOAD Owner 855-743-2247 |
Organization Subpart ? | No |
Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine |
Additional Taxonomies | 363L00000X Nurse Practitioner |
Enumeration Date | 2024-05-31 |
Last Update Date | 2024-05-31 |