| NPI | 1447964846 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL PORTSMORE Authorized Person 855-576-8745 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 2080P0006X Pediatrics Developmental - Behavioral Pediatrics |
| Enumeration Date | 2023-01-10 |
| Last Update Date | 2025-06-19 |