Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | OT020560 | PA |
NPI | 1023699493 |
---|---|
Provider Name | Bryan Paulo Lopez Canlas |
First Address | Easton, PA 18045-5670 |
Second Address | Easton, PA 18045-5670 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2021 |
Last Update Date | 06/09/2021 |