| NPI | 1912671454 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY SPARTA Owner 848-702-1688 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2021-08-07 |
| Last Update Date | 2022-07-19 |