Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 2076 | NE |
NPI | 1073114997 |
---|---|
Provider Name | Dr. Adam Young |
First Address | Waverly, NE 68462-2562 |
Second Address | Waverly, NE 68462-2562 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2020 |
Last Update Date | 06/11/2020 |