| NPI | 1902350069 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN STOUT Practice Administrator 734-712-0077 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI M118019) |
| Enumeration Date | 2016-08-06 |
| Last Update Date | 2016-08-06 |