| NPI | 1811516503 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY MCCLINTOCK Compliance Officer 866-374-6628 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0600X Psychiatry & Neurology, Clinical Neurophysiology |
| Enumeration Date | 2020-04-13 |
| Last Update Date | 2022-04-05 |