Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 170100000X | Medical Geneticist | 6452A | WY |
Y | 207L00000X | Anesthesiologist | 6452A | WY |
NPI | 1093803918 |
---|---|
Provider Name | David Barahal |
First Address | Casper, WY 82601-2454 |
Second Address | Casper, WY 82601-2454 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 20/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
115884800 | (05) | WY |