| NPI | 1023170115 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY RATOWSKI Director Office Provider Affairs 248-703-2003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: MI 830190) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2024-03-06 |