| NPI | 1417525692 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | INNOCENT OMALE Owner 469-684-2022 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2021-06-15 |
| Last Update Date | 2021-06-15 |