| 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 |