| NPI | 1205116399 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROYA GHADIMI Owner 239-593-6120 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: FL ME107176) |
| Enumeration Date | 2011-08-22 |
| Last Update Date | 2011-12-20 |