Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003495136 |
---|---|
Provider Name | Elijah Muhammad |
First Address | Grand Rapids, MI 49507 |
Second Address | Grand Rapids, MI 49507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2021 |
Last Update Date | 06/04/2021 |