Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Sep 4, 2024
License(s)
5601012608 (MI)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 5075 MIDDLESEX ST | Dearborn, MI 48126-5017 | 313-358-5042 |
| LOCATION | 2539 ELLSWORTH RD | Ypsilanti, MI 48197-5619 | 734-330-2800 |
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