| NPI | 1902117179 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEOFFREY MARK GONZALES Owner 210-482-9913 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 638567) |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2010-06-23 |