| NPI | 1265267231 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRINCEWILL FONTA President 774-888-8321 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2024-09-07 |
| Last Update Date | 2025-03-17 |