| NPI | 1255066577 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARVIN WALLACE WILLIAMS Owner 210-883-5936 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2022-07-20 |
| Last Update Date | 2022-07-20 |