| NPI | 1972300663 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAM KHAN Credentialing Manager 786-788-5080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2025-02-28 |
| Last Update Date | 2025-04-23 |