| NPI | 1104672617 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DUSTIN VON HOLTEN Founder 347-573-9479 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2024-04-25 |
| Last Update Date | 2024-04-25 |