| NPI | 1689453334 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PEARL EZEGRIM Authorized Official 424-622-8428 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2023-09-22 |
| Last Update Date | 2023-09-22 |