| NPI | 1245601988 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAROL MCKINLEY Designated Agent 985-781-0548 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2015-10-07 |
| Last Update Date | 2022-09-16 |