| NPI | 1407662455 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SASIDHARAN TARAVATH President/CEO 910-833-0356 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2024-12-04 |
| Last Update Date | 2024-12-04 |