| NPI | 1821700188 |
|---|---|
| Other Name | WISCONSIN |
| Entity Type | Organization |
| Authorized Contact | MICHAEL HUY LE Chief Medical Officer 657-237-2450 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Enumeration Date | 2022-12-19 |
| Last Update Date | 2022-12-19 |