Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 2301002868 | MI |
NPI | 1447312921 |
---|---|
Provider Name | Dr. Bruce Kelvin Sherman |
First Address | Lapeer, MI 48446-9325 |
Second Address | Lapeer, MI 48446-3077 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1012591 | (02) | MI |
P33622F | (02) | MI |