| NPI | 1598028052 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AHMED A SHATLA Owner 315-266-2078 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: NY 214256) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2012-06-20 |