Individual
BRIAN WALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
41621 W 11 MILE RD, NOVI, MI 48375-1804
(248) 299-0030
(248) 438-1566
Mailing address
3342 ASH DR, #10106, LAKE ORION, MI 48359-2350
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703084441
MI
Other
Enumeration date
12/14/2012
Last updated
12/14/2012
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