Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | 5501013601 | MI |
NPI | 1831363274 |
---|---|
Provider Name | Kistur Ajith Jain |
First Address | Mason, MI 48854-9425 |
Second Address | Mason, MI 48854-9425 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2008 |
Last Update Date | 16/04/2008 |