Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 00000000 | MI |
NPI | 1003035445 |
---|---|
Provider Name | Byron Otoniel Salguero |
First Address | Grandville, MI 49418-2590 |
Second Address | Grandville, MI 49418-2590 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 17/02/2012 |