| NPI | 1841655115 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ED MASHAK Owner 904-612-0668 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| Enumeration Date | 2015-12-30 |
| Last Update Date | 2015-12-30 |