| NPI | 1891396131 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEONARD A. ROLLMAN Clinic Director 888-794-4752 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2020-11-03 |
| Last Update Date | 2021-09-03 |