Individual
JORDAN LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12000 E 12 MILE RD, WARREN, MI 48093-3570
(313) 417-6752
Mailing address
12000 E 12 MILE RD, WARREN, MI 48093-3570
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/24/2023
Last updated
04/24/2023
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