| NPI | 1780029074 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK WOLODKOWICZ Owner 248-275-5221 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501005051) |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MI 4301039079) | |
| Enumeration Date | 2013-05-01 |
| Last Update Date | 2014-07-08 |