| NPI | 1649647876 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID WILKINS Owner 231-375-8065 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MI 5601002156) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801062394) |
| Enumeration Date | 2015-08-24 |
| Last Update Date | 2016-04-14 |