| NPI | 1639523277 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN VYVERBERG Owner 228-331-3310 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MS 22206) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MS 22206) |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2016-04-20 |