{
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"FirstLinePracticeLocationAddress": "4101 UNIVERSITY AVE",
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"EnumerationDate": "03/27/2025",
"LastUpdateDate": "03/27/2025",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BROADNAX",
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"Taxonomies": {
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"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}