| NPI | 1992903363 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE ALLEN FOWLER President 616-450-4601 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301006137) |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2024-05-16 |