| NPI | 1649820416 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAFON FOMUJANG Medical Director 405-549-6290 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2019-09-13 |
| Last Update Date | 2023-04-19 |