| NPI | 1114108974 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL JAMES VREDEVOOGD President 586-741-0295 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MI 63010066531) |
| Additional Taxonomies | 261QM0850X Clinic/Center Adult Mental Health (Licence: MI 63010066531) |
| Enumeration Date | 2007-11-21 |
| Last Update Date | 2007-11-21 |