| NPI | 1265603716 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUDY I. Office Manager 586-443-4402 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging |
| Enumeration Date | 2008-03-12 |
| Last Update Date | 2012-01-26 |