Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 20301007597 | MI |
NPI | 1487756987 |
---|---|
Provider Name | Gregory Thomas Thornton |
First Address | Fraser, MI 48026-3576 |
Second Address | Fraser, MI 48026-3576 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2006 |
Last Update Date | 09/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U70587 | (02) | MI |