| NPI | 1639996242 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEMISOLA EBIETOMIYE Owner Of Entity 347-378-3144 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2024-09-24 |
| Last Update Date | 2024-09-24 |