| NPI | 1760206569 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MISKI ISSAK Director 380-249-9026 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TM1800X Psychologist Mental Retardation & Developmental Disabilities |
| Enumeration Date | 2024-11-09 |
| Last Update Date | 2024-11-09 |