Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 2301010099 | MI |
NPI | 1427495423 |
---|---|
Provider Name | Dr. Jacob Karl |
First Address | Westland, MI 48185-2481 |
Second Address | Westland, MI 48185-2481 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2013 |
Last Update Date | 30/05/2013 |