Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 21942 | CA |
NPI | 1124048970 |
---|---|
Provider Name | Dr. Kirk Roberts Ryskamp |
First Address | Rancho Mirage, CA 92270-1766 |
Second Address | Rancho Mirage, CA 92270-1766 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 08/07/2007 |