| NPI | 1861293516 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMUEL BASIAKA ITIE CEO/Provider 248-707-9554 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2025-03-20 |
| Last Update Date | 2025-04-29 |