NPI | 1174076822 |
---|---|
Entity Type | Organization |
Authorized Contact | JUSTIN CLARK Physician 907-644-8446 |
Organization Subpart ? | No |
Primary Taxonomy | 208600000X Surgery (Licence: AK 1033013) |
Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
Enumeration Date | 2016-07-29 |
Last Update Date | 2024-11-05 |