Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 3054 | SC |
NPI | 1285604447 |
---|---|
Provider Name | Dr. Henry Walter Latter JR. |
First Address | Charleston, SC 29414-6933 |
Second Address | Charleston, SC 29407-7859 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 08/07/2007 |