| NPI | 1689025389 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY DERSTINE Owner 814-689-9744 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD056013L) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: PA MD056013L) |
| Enumeration Date | 2016-06-24 |
| Last Update Date | 2016-06-24 |