| NPI | 1760445597 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN GOULD President 839-200-7510 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 363LF0000X Nurse Practitioner Family | |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2022-01-12 |