NPI | 1548704620 |
---|---|
Entity Type | Organization |
Authorized Contact | KRISTEN HANSEN Administrator 731-343-8336 |
Organization Subpart ? | No |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
Additional Taxonomies | 207R00000X Internal Medicine |
Enumeration Date | 2016-12-08 |
Last Update Date | 2019-01-24 |