| NPI | 1710698816 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRETT COULTER Contracting 929-466-1305 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics Developmental - Behavioral Pediatrics |
| Enumeration Date | 2022-12-09 |
| Last Update Date | 2022-12-09 |