Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 4301054589 | MI |
NPI | 1043347354 |
---|---|
Provider Name | Farris Gulli |
First Address | Royal Oak, MI 48073 |
Second Address | Commerce Township, MI 48382-2201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2007 |
Last Update Date | 08/07/2007 |