| NPI | 1891451035 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILIP MENARD Manager 734-657-1470 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics |
| Additional Taxonomies | 208000000X Pediatrics |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2021-11-11 |
| Last Update Date | 2023-05-01 |