Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1295493609 |
---|---|
Provider Name | Mirsida Gega |
First Address | Shelby Township, MI 48317-1347 |
Second Address | Shelby Township, MI 48317-1347 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2021 |
Last Update Date | 02/12/2021 |