| NPI | 1225536469 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY A MUNRO Administrator 248-881-4843 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901012911) |
| Enumeration Date | 2018-01-23 |
| Last Update Date | 2024-03-04 |