| NPI | 1396317111 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EVAN OWEN FOSTER DERANJA Partner 331-222-7985 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084B0040X Psychiatry & Neurology Behavioral Neurology & Neuropsychiatry |
| Enumeration Date | 2021-07-12 |
| Last Update Date | 2024-06-21 |