| NPI | 1043083694 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CREDENTIALING DEPARTMENT Office Manager/Business Staff 888-291-5143 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2023-11-06 |
| Last Update Date | 2023-11-16 |