| NPI | 1356036529 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ABIODUN AKINOLA OLATUBOSUN Apn 862-220-6803 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2023-04-05 |
| Last Update Date | 2026-08-26 |