Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 272833426 | MI |
NPI | 1275842809 |
---|---|
Provider Name | Jason Oliver Preston |
First Address | Detroit, MI 48205-4829 |
Second Address | Detroit, MI 48205-4829 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2010 |
Last Update Date | 30/09/2010 |