| NPI | 1023130853 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIE ANN BROOKS Physician Assistant 248-210-8883 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MI 5601003725) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2020-08-22 |