| NPI | 1184353310 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDUARD TSYRULNYKOV Owner 414-915-5665 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2022-06-04 |
| Last Update Date | 2023-08-21 |