Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | MT192814 | PA |
N | 2084N0400X | Neurologist | 35123456 | OH |
Y | 2084N0400X | Neurologist | ME129764 | FL |
N | 2084N0600X | Clinical Neurophysiologist | 35123456 | OH |
NPI | 1497989800 |
---|---|
Provider Name | Dr. Daniel Lai |
First Address | Melbourne, FL 32935-8661 |
Second Address | Melbourne, FL 32935-8661 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2009 |
Last Update Date | 16/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0105338 | (05) | OH |
H333510 | MEDICARE PTAN (01) | OH |