| NPI | 1801611421 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICIA LICANO Credentialing Lead 719-201-6108 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0402X Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology |
| Enumeration Date | 2024-11-19 |
| Last Update Date | 2024-11-19 |