Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 0101033079 | VA |
NPI | 1144258419 |
---|---|
Provider Name | David Lander |
First Address | Ann Arbor, MI 48105-1598 |
Second Address | Blacksburg, VA 24060-7017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 03/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A72624 | (02) |