Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225CX0006X | Orientation and Mobility Training Provider | B203734287 | MI |
NPI | 1811135775 |
---|---|
Provider Name | Anthony Frank Balcerzak |
First Address | Clinton Twp,Mi, 48036:, MI 48047 |
Second Address | Clinton Twp, MI 48036 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2009 |
Last Update Date | 30/01/2009 |