| NPI | 1508493156 |
|---|---|
| Former Legal Business Name | AVICENNA, PLLC |
| Entity Type | Organization |
| Authorized Contact | REZA HOSSEINI GHOMI COO 406-200-8471 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2024-03-29 |