| NPI | 1043920119 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STELLA ALAH-TIH FONGOD Owner Of The Entity 424-221-0834 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2022-11-30 |
| Last Update Date | 2024-04-30 |