| NPI | 1578280293 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN WILLIAM SHAW Co Founder 917-575-5662 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2022-10-24 |
| Last Update Date | 2022-10-24 |