| NPI | 1124244157 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS VAN DOREN Owner 269-353-3503 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0015X Psychiatry & Neurology, Psychosomatic Medicine (Licence: MI TV033744) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2020-08-22 |