Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 5201004910 | MI |
NPI | 1417331109 |
---|---|
Provider Name | Mr. Sadhan Mahanta |
First Address | Canton, MI 48188-3252 |
Second Address | Canton, MI 48188-3252 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2015 |
Last Update Date | 19/08/2016 |