| NPI | 1184142176 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY MCCLINTOCK Compliance Officer 866-374-6628 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology |
| Enumeration Date | 2017-08-30 |
| Last Update Date | 2022-06-06 |