| NPI | 1972071660 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONGMI LEE Principal 929-352-0454 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health |
| Enumeration Date | 2018-11-11 |
| Last Update Date | 2019-12-20 |