| NPI | 1740602077 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEN R MAYNE Owner 989-839-8865 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MI BM406830) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601006775) |
| 363A00000X Physician Assistant (Licence: MI 5601003053) | |
| Enumeration Date | 2014-01-06 |
| Last Update Date | 2014-01-06 |