| NPI | 1225559339 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY JAY ALLEN Owner 307-432-3924 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WY 6318A) |
| Additional Taxonomies | 293D00000X Physiological Laboratory |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2022-07-21 |