| NPI | 1487313557 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEANNE GOSS Managing Member 999-999-9999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 293D00000X Physiological Laboratory |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology |
| Enumeration Date | 2021-12-15 |
| Last Update Date | 2022-01-17 |