Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 4301046408 | MI |
NPI | 1376725184 |
---|---|
Provider Name | Dr. Jack Edward Juni |
First Address | Canton, MI 48187-2437 |
Second Address | Canton, MI 48187-2437 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2007 |
Last Update Date | 04/12/2007 |