| NPI | 1669253571 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY KAUK Owner 313-587-7228 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health |
| Additional Taxonomies | 261QH0100X Clinic/Center Health Service |
| Enumeration Date | 2023-10-09 |
| Last Update Date | 2023-10-09 |