| NPI | 1306971130 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDI D WIDMAIER Office Manager 386-304-3444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME56967) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2020-08-22 |