| NPI | 1932064326 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AVASHKAR WOOMPATH Owner 570-343-2383 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine |
| Additional Taxonomies | 208VP0000X |
| Enumeration Date | 2025-12-18 |
| Last Update Date | 2026-01-22 |