| NPI | 1093164063 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALAN K HAGSTROM Sole Owner 239-404-3379 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME114651) |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2016-06-09 |