Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DTP552 | FL |
NPI | 1114207115 |
---|---|
Provider Name | Akshay Aswatha Kumarswamy |
First Address | Davie, FL 33328-2018 |
Second Address | Davie, FL 33328-2018 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2011 |
Last Update Date | 22/08/2011 |