Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | G15320 | CA |
NPI | 1710092580 |
---|---|
Provider Name | Dr. David Wiley Winsor |
First Address | Los Angeles, CA 90057-1901 |
Second Address | Los Angeles, CA 90057-1901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A90379 | (02) | CA |