| NPI | 1093017162 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OMA GAMA Part Owner 252-414-8202 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2010-11-23 |
| Last Update Date | 2010-12-22 |