| NPI | 1851782346 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN LADD Manager 616-723-3731 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA3036) |
| Enumeration Date | 2015-02-05 |
| Last Update Date | 2015-02-05 |