Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor |
NPI | 1023313665 |
---|---|
Provider Name | Mr. Phillip Jay Rosenbaum |
First Address | Pontiac, MI 48341-2244 |
Second Address | Pontiac, MI 48341-2244 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2011 |
Last Update Date | 12/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1883825 | (05) | MI |