| NPI | 1275154585 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGE MICHAEL WICKHAM General Partner 480-531-5973 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2020-04-28 |
| Last Update Date | 2020-04-28 |