| NPI | 1568056570 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON MUSSMAN Provider/Owner 989-255-4794 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery |
| Enumeration Date | 2021-02-22 |
| Last Update Date | 2021-02-22 |