| NPI | 1417731563 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN GREEN Owner 302-401-9193 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 103T00000X Psychologist |
| Enumeration Date | 2023-08-21 |
| Last Update Date | 2023-08-21 |