| NPI | 1245632108 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DWAYNE DUNLAP Surgical Assistant 248-346-2748 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: TX SA00368) |
| Enumeration Date | 2014-09-23 |
| Last Update Date | 2014-11-07 |