Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | CH7872 | FL |
NPI | 1144362856 |
---|---|
Provider Name | Dr. Brian Patrick Walsh |
First Address | W Melbourne, FL 32904-3864 |
Second Address | W Melbourne, FL 32904-3864 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2007 |
Last Update Date | 08/07/2007 |