| NPI | 1871482166 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WALTER LEWIS TOLLER Owner 667-207-3552 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine |
| Enumeration Date | 2025-07-01 |
| Last Update Date | 2025-07-01 |