| NPI | 1104378363 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY L SUSI CEO 772-567-4311 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL 4029) |
| Enumeration Date | 2016-11-03 |
| Last Update Date | 2019-09-16 |