| NPI | 1649160862 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VLADIMIR VICTOR EUGENE Managing Member 224-900-6463 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| Enumeration Date | 2025-07-08 |
| Last Update Date | 2025-07-08 |