Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 0018845 | GA |
NPI | 1114059136 |
---|---|
Provider Name | Dr. Irineo Mina Sibal |
First Address | Augusta, GA 30906-3815 |
Second Address | Augusta, GA 30906-3815 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2007 |
Last Update Date | 08/07/2007 |