Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 35.099392 | OH |
NPI | 1003065905 |
---|---|
Provider Name | Clifford Quinn Cabansag |
First Address | Mason, OH 45040-3104 |
Second Address | Mason, OH 45040-3104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2008 |
Last Update Date | 18/03/2015 |