| NPI | 1932731130 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN KLINCK Owner 480-216-1789 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry |
| Additional Taxonomies | 261Q00000X |
| Enumeration Date | 2020-02-06 |
| Last Update Date | 2020-02-06 |