Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 815 | HI |
NPI | 1356425532 |
---|---|
Provider Name | Dr. George Ermano Raquel |
First Address | Waipahu, HI 96797-1900 |
Second Address | Waipahu, HI 96797-1900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 08/07/2007 |