| NPI | 1790104487 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WESAM HASSAN MOUSTAFA HUSSEIN Owner 346-220-3534 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: VA 0101250764) |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2024-08-12 |