| NPI | 1477099596 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ILANA SPRAGUE Physician Assistant 248-505-9648 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9110078) |
| Enumeration Date | 2017-01-12 |
| Last Update Date | 2017-01-12 |