Home » » 1164542593

1164542593 deactivated on Apr 24, 2019

NPI 1164542593 deactivated on Apr 24, 2019.

profile-icon Basic Information

Practice Location , ,
Practice Location Phone
Practice Location Fax
Gender
Specialty InNot specified
NPI ?1164542593
Entity Type
Enumeration Date ?
Last Update Date ?
Note:
NPI: National Provider Identifier issued to health care providers by Centers for Medicare and Medicaid Services (CMS).