| NPI | 1376508333 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARAH STARKEL Supervisor, Enrollment 248-680-8206 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2022-06-28 |