| NPI | 1538677026 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HAROLD FRANKLIN ROTH Provider 517-485-1789 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MI 5101007838) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704259692) |
| Enumeration Date | 2018-01-18 |
| Last Update Date | 2018-01-18 |