| NPI | 1972371888 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER TIKUM Owner/Apn 848-801-9248 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2023-12-20 |
| Last Update Date | 2024-08-08 |