Individual
DANIEL RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1969 N WAYNE RD, WESTLAND, MI 48185-3773
(734) 727-9094
Mailing address
2160 LAKEVIEW DR APT 267, YPSILANTI, MI 48198-6740
(708) 207-1987
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2601001958
MI
Other
Enumeration date
03/19/2020
Last updated
03/19/2020
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