Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 2901022651 | MI |
NPI | 1750874863 |
---|---|
Provider Name | Dr. Andrew Michael Gasior |
First Address | Milford, MI 48381-4726 |
Second Address | Kalamazoo, MI 49001-6144 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2018 |
Last Update Date | 13/06/2018 |