Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | D10784 | MN |
NPI | 1760469696 |
---|---|
Provider Name | Dr. Kevin Rand Torske |
First Address | Portsmouth, VA 23708 |
Second Address | Portsmouth, VA 23708-2111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2005 |
Last Update Date | 12/03/2020 |