Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | VA |
NPI | 1871641381 |
---|---|
Provider Name | Ahmad Amin |
First Address | Fairfax, VA 22030-4515 |
Second Address | Manassas, VA 20109-2804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 08/07/2007 |