| NPI | 1174665988 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TOM BRUSSEAU Mgr 248-663-9846 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MI 50011601) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2020-08-22 |