| NPI | 1821135831 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MILTON JAMES GROSENBACH Dr Owner 810-678-8898 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301003782) |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization (Licence: MI 4101005216) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2016-06-27 |