Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 5101005336 | MI |
NPI | 1104031574 |
---|---|
Provider Name | Ronald Edmund Gren |
First Address | Northville, MI 48167-2650 |
Second Address | Northville, MI 48167-2650 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2007 |
Last Update Date | 08/07/2007 |