| NPI | 1679280671 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETERSON GO President 909-236-0338 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry |
| Enumeration Date | 2022-10-31 |
| Last Update Date | 2022-10-31 |