| NPI | 1710435052 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN MARC WAGNER Managing Director 915-215-4478 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2016-09-15 |
| Last Update Date | 2016-09-15 |