Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1235669771 |
---|---|
Provider Name | Andrew Joseph Lee |
First Address | Okemos, MI 48864-1989 |
Second Address | Okemos, MI 48864-1989 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2017 |
Last Update Date | 18/06/2017 |