| NPI | 1215711676 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PURNA SURAPANENI Owner 810-445-8405 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry |
| Enumeration Date | 2023-08-24 |
| Last Update Date | 2023-08-24 |