| NPI | 1518662485 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENRICK LICORISH Corporation President / Physician 949-244-0104 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2023-03-31 |
| Last Update Date | 2023-03-31 |