| NPI | 1659089951 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICK D BRAATZ Credentialing Specialist 844-646-3247 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2022-11-07 |
| Last Update Date | 2026-07-08 |