| NPI | 1568419240 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY MICHAEL KOTLARZ Owner 248-398-6459 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2022-07-08 |