| NPI | 1710635297 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICK AMIN Credentialing 717-910-6512 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2022-03-14 |
| Last Update Date | 2022-03-14 |