Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 6802059687 | MI |
NPI | 1003248360 |
---|---|
Provider Name | Robert Bray |
First Address | Ferndale, MI 48220-1962 |
Second Address | Ferndale, MI 48220-1962 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2013 |
Last Update Date | 08/08/2013 |