| NPI | 1649819525 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WHITNEY CHARNELL DESSIO Owner 631-398-6591 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine |
| Enumeration Date | 2019-12-25 |
| Last Update Date | 2019-12-25 |