| NPI | 1184165862 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TISH J BROWN Practice Administrator 386-944-9813 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME101968) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: ME101968) |
| Enumeration Date | 2017-03-15 |
| Last Update Date | 2024-01-31 |