| NPI | 1609627595 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DUSTIN BRADFORD VON HOLTEN Pmhnp 347-573-9479 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2024-03-28 |
| Last Update Date | 2024-03-28 |