| NPI | 1134419872 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIANNE G KROUK Director Of Corporation 239-220-3543 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: FL OS10199) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL OS10199) |
| Enumeration Date | 2011-04-14 |
| Last Update Date | 2011-04-14 |