| NPI | 1639580061 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT GRANT NIZNIK CEO 786-202-6338 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 103T00000X Psychologist |
| 174400000X Specialist | |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine | |
| Enumeration Date | 2014-05-20 |
| Last Update Date | 2014-05-21 |