Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1326522368 |
---|---|
Provider Name | Micah Duncan-Walker |
First Address | Sterling Hts, MI 48313-5412 |
Second Address | Sterling Hts, MI 48313-5412 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2018 |
Last Update Date | 15/09/2018 |