| NPI | 1013147834 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHIL DETOURNILLON Treasurer 954-241-0303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME63070) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL ARNP1348922) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL ARNP2053552) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL ARNP2876402) | |
| Enumeration Date | 2009-07-15 |
| Last Update Date | 2009-07-15 |