| NPI | 1750040598 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTINA MUSIC Director Provider Enrollment 877-892-9815 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 208600000X Surgery |
| Enumeration Date | 2021-12-09 |
| Last Update Date | 2024-08-07 |