| NPI | 1619371564 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLENE SHARON STAFF Physician Assistant 248-971-9178 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601007192) |
| Enumeration Date | 2014-10-21 |
| Last Update Date | 2014-10-21 |