| NPI | 1750990438 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHANNA WILSON Owner 419-951-2020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2020-07-28 |
| Last Update Date | 2020-07-28 |