| NPI | 1780454587 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW DENOTTER Owner 248-894-7024 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2024-01-03 |
| Last Update Date | 2024-06-03 |