| NPI | 1275672073 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VAN WILLIAM LUETHKE Administrator 804-272-0114 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0301X Psychiatry & Neurology, Brain Injury Medicine (Licence: VA 0101036956) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2023-05-11 |