Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 230101687 | MI |
NPI | 1326523630 |
---|---|
Provider Name | Dr. Thomas William Bender |
First Address | Clinton Township, MI 48035-4238 |
Second Address | Clinton Township, MI 48035-4238 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2018 |
Last Update Date | 02/10/2018 |