Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1073083051 |
---|---|
Provider Name | Louis Robert Gignac |
First Address | Iron Mountain, MI 49801-4760 |
Second Address | Iron Mountain, MI 49801-4760 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2018 |
Last Update Date | 03/12/2018 |