| NPI | 1306509674 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS MICHAEL ROARTY Np 267-467-9041 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2021-10-14 |
| Last Update Date | 2021-10-14 |