NPI | 1104066679 |
---|---|
Entity Type | Organization |
Authorized Contact | JEFFREY DEGROAT Manager 586-776-3366 |
Organization Subpart ? | No |
Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MI 6301012619) |
Enumeration Date | 2009-02-24 |
Last Update Date | 2009-02-24 |