| NPI | 1912496712 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY MARK BYKER Owner/Operator 616-894-2441 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AZ 6403) |
| Enumeration Date | 2018-05-07 |
| Last Update Date | 2018-07-03 |