Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 5101024175 | MI |
NPI | 1033602040 |
---|---|
Provider Name | Dr. David Rastall |
First Address | Williamston, MI 48895-9328 |
Second Address | Lansing, MI 48912-1896 |
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 |