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 |