Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175F00000X | Naturopath | MI | |
Y | 175L00000X | Homeopath | MI |
NPI | 1124650643 |
---|---|
Provider Name | Mr. Anthony Martinez Beven |
First Address | Lake Orion, MI 48359-1507 |
Second Address | Lake Orion, MI 48359-1507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2020 |
Last Update Date | 12/02/2020 |