| NPI | 1225880677 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KISHAN NALLAPULA Owner 386-853-4835 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry |
| Enumeration Date | 2024-04-01 |
| Last Update Date | 2024-04-01 |