Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 6801091718 | MI |
NPI | 1003143512 |
---|---|
Provider Name | Devin Dombrowski |
First Address | Jackson, MI 49202-2179 |
Second Address | Jackson, MI 49202-2179 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2009 |
Last Update Date | 05/11/2009 |