Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 4301049185 | MI |
NPI | 1477845618 |
---|---|
Provider Name | Dr. Bashar Abou-Rass |
First Address | Bloomfield, MI 48301-3640 |
Second Address | Bloomfield, MI 48301-3640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2011 |
Last Update Date | 06/05/2011 |