| NPI | 1699463190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HASSAN IBRAHIM Owner/Provider 929-801-1540 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2023-04-24 |
| Last Update Date | 2023-04-24 |