Individual
MR. SCOTT DAVID SAMPLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MASTERS OF ARTS
Contact information
Practice address
22111 GRIX ST, WOODHAVEN, MI 48183-3247
(734) 558-4217
Mailing address
22111 GRIX ST, WOODHAVEN, MI 48183-3247
(734) 558-4217
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
06/27/2016
Last updated
06/27/2016
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