| NPI | 1184297954 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MORGAN GLAZER Authorized Official 248-550-4800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine |
| Additional Taxonomies | 261QP3300X Clinic/Center Pain |
| Enumeration Date | 2021-07-20 |
| Last Update Date | 2022-05-20 |