| NPI | 1174909592 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IAN FRAZIER LYTLE Physician/Owner 313-399-9775 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MI 4301088089) |
| Enumeration Date | 2015-08-07 |
| Last Update Date | 2015-09-18 |