| NPI | 1740673300 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICK JOHN LARRAZABAL Owner/Provider 386-334-1295 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME0020477) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME0086562) |
| Enumeration Date | 2015-03-06 |
| Last Update Date | 2018-03-28 |