| NPI | 1851075881 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE LEE CICHON Manager 725-500-0400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0301X Psychiatry & Neurology, Brain Injury Medicine |
| Enumeration Date | 2023-06-12 |
| Last Update Date | 2026-07-15 |