| NPI | 1972987998 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY MORROW Billing Manager 907-762-2820 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) |
| Additional Taxonomies | 103TR0400X Psychologist, Rehabilitation |
| Enumeration Date | 2015-07-20 |
| Last Update Date | 2015-07-20 |