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 |