Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 4859 | LA |
NPI | 1063611721 |
---|---|
Provider Name | Dr. Bryan Paul Bohning |
First Address | Metairie, LA 70002 |
Second Address | Metairie, LA 70002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2007 |
Last Update Date | 13/07/2007 |