| NPI | 1720778509 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID LAURENT MUGOMOKE Director 469-910-4181 |
| Organization Subpart ? | No |
| Primary Taxonomy | 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) |
| Enumeration Date | 2023-05-15 |
| Last Update Date | 2023-05-15 |