| NPI | 1710655139 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATASHA KRAUTH Owner 346-816-9150 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine |
| Additional Taxonomies | 2083B0002X Preventive Medicine, Obesity Medicine |
| Enumeration Date | 2021-08-31 |
| Last Update Date | 2021-08-31 |