Individual
JOHNATHAN AGIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LLP
Contact information
Practice address
1440 TORREY RD STE E, FENTON, MI 48430
(810) 288-6652
Mailing address
1440 TORREY RD, STE E, FENTON, MI 48430-1340
(810) 210-4894
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301016217
MI
Other
Enumeration date
02/15/2015
Last updated
06/04/2018
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