Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 042-0008329 | VT |
NPI | 1043238017 |
---|---|
Provider Name | Dr. David Nielsen Krag |
First Address | Shelburne, VT 05482-4415 |
Second Address | Burlington, VT 05401-1473 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 08/07/2007 |