| NPI | 1013367556 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STUART J SHAFER Mbr 772-492-7051 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL ME72269) |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2018-02-06 |