| NPI | 1124348362 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IDA ZACK Psychologist 248-546-6711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301001930) |
| Enumeration Date | 2010-06-10 |
| Last Update Date | 2010-10-20 |