| NPI | 1184822769 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAVINDER P MEDIRATTA Owner 269-342-0606 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MI RM4301052512) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MI 6401009051) |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2008-10-09 |