| NPI | 1003121658 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OLENA GORDON Resident 248-842-9353 |
| Organization Subpart ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2010-08-06 |
| Last Update Date | 2022-07-21 |