Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | MD-21256 | HI |
NPI | 1043745334 |
---|---|
Provider Name | Benjamin Schnakenberg |
First Address | Joint Base Pearl Harbor Hickam, HI 96860-4908 |
Second Address | Joint Base Pearl Harbor Hickam, HI 96860-4908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2017 |
Last Update Date | 03/09/2020 |