| NPI | 1508658907 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN QASAWA Owner 586-630-7699 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2025-05-21 |
| Last Update Date | 2025-06-04 |