| NPI | 1679106421 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARCUS BRUNO Owner 337-962-9049 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 1223G0001X Dentist General Practice | |
| Enumeration Date | 2020-02-20 |
| Last Update Date | 2024-02-29 |