NPI Registration Record

Provider / Organization	NPI	Date Certified
	1821697467	0000-00-00

The organization is registered with the National Plan and Provider Enumeration System (NPPES) and has the assigned NPI of 1821697467.

⚠️ Deactivated 2020-10-26

Contact Endpoints

Direct Messaging Address []	[email protected]
CONNECT URL []	[email protected]	Direct

HPT Codes

Code	Practice	License No State

OPI Codes

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