| NPI | 1871635607 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIRANDA MACIAG Medical Billing Manager 248-593-1717 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI dg046562) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2008-03-18 |