| NPI | 1649592817 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROCELIOUS GOODSON CEO 734-968-8682 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MI 5601004396) |
| Enumeration Date | 2010-02-16 |
| Last Update Date | 2010-02-16 |