| NPI | 1447029244 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARC EXILUS Owner 302-722-4740 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2023-12-21 |
| Last Update Date | 2024-03-05 |