| NPI | 1205675279 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMANTHA MIDDLETON Authorized Agent 989-899-7065 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2024-05-21 |
| Last Update Date | 2024-11-22 |