| NPI | 1356635239 |
|---|---|
| Former Legal Business Name | THOMAS R. WIKSTROM, MD |
| Entity Type | Organization |
| Authorized Contact | THOMAS R. WIKSTROM Psychiatrist/Owner 904-396-0425 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME52161) |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2012-01-27 |