| NPI | 1053007682 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GABRIEL DIETSCH Owner 954-859-1136 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Additional Taxonomies | 261QI0500X Clinic/Center, Infusion Therapy |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2023-04-17 |
| Last Update Date | 2023-04-17 |