| NPI | 1922690361 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA LANDERS Director Of Credentialing 304-429-1088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2021-02-08 |
| Last Update Date | 2021-07-07 |