NPI Registration Record
Provider / Organization | NPI | Date Certified |
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| 1356957831 | 0000-00-00 |
The organization is registered with the National Plan and Provider Enumeration System (NPPES) and has the assigned NPI of 1356957831.
⚠️ Deactivated 2020-11-02
HPT Codes
Code | Practice | License No State |
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