| NPI | 1770596587 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM PHILLIP BLOOM Managing Partner 248-649-9202 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301006833) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2020-08-22 |