Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 35614 | CA |
NPI | 1104902345 |
---|---|
Provider Name | Dr. Brian Neal Hollander |
First Address | Novato, CA 94947 |
Second Address | Novato, CA 94947 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 08/07/2007 |