Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E1619 | CA |
Y | 222Z00000X | Podiatrist | E1619 | CA |
NPI | 1003848235 |
---|---|
Provider Name | Dr. Marc D Selner |
First Address | Studio City, CA 91604-1710 |
Second Address | Studio City, CA 91604-1710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 16/11/2007 |