| NPI | 1124819172 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTINA MUSIC Director, Provider Enrollment 877-892-9815 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology |
| Enumeration Date | 2025-05-16 |
| Last Update Date | 2025-05-16 |