| NPI | 1891036521 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA M. WALDRON Billing Administrator 772-221-0190 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry |
| Enumeration Date | 2013-03-05 |
| Last Update Date | 2013-03-05 |