| NPI | 1215312947 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEDA HENDERSON Director Of Operations 772-713-6290 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: FL ME106951) |
| Enumeration Date | 2015-07-23 |
| Last Update Date | 2015-07-23 |