Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 6301014617 | MI |
Y | 103T00000X | Psychologist | 6301014617 | MI |
NPI | 1003267329 |
---|---|
Provider Name | Junichi Shimaoka |
First Address | Ann Arbor, MI 48104-3816 |
Second Address | Ann Arbor, MI 48104-3816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2016 |
Last Update Date | 28/06/2016 |