{
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"FirstLineMailingAddress": "1906 CLINT MOORE RD STE 4",
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"FirstLinePracticeLocationAddress": "1906 CLINT MOORE RD STE 4",
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"EnumerationDate": "06/21/2022",
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"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "YUSHUVA",
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"Taxonomies": {
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}