Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | MI |
NPI | 1164983961 |
---|---|
Provider Name | Matthew Warner |
First Address | Detroit, MI 48202-3216 |
Second Address | Detroit, MI 48202-3216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2019 |
Last Update Date | 26/03/2019 |