| NPI | 1154471837 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL CASTILLO CFO 734-615-0574 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2021-05-03 |