| NPI | 1194258376 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GWYNN A STUP Owner 302-674-3168 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: DE 2017602789) |
| Additional Taxonomies | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: DE 2017602789) |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2022-07-21 |