Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 14081 | KY |
NPI | 1013143163 |
---|---|
Provider Name | Andrievs Dzenitis |
First Address | Louisville, KY 40207-4660 |
Second Address | Louisville, KY 40202-1622 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2009 |
Last Update Date | 03/06/2009 |