Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 6801064714 | MI |
NPI | 1003119561 |
---|---|
Provider Name | Dr. Roger William Manela |
First Address | Novi, MI 48375-4561 |
Second Address | Novi, MI 48375-4561 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2010 |
Last Update Date | 06/12/2010 |