| NPI | 1255629358 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNTHIA ZALDOKAS Mgr Provider Enrollment 517-355-3503 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MI 6301014684) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301006498) |
| Enumeration Date | 2011-07-11 |
| Last Update Date | 2012-04-13 |