Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | DMO31370 | CA |
NPI | 1639199417 |
---|---|
Provider Name | Dr. Michael Lee Rowe |
First Address | Covina, CA 91723-1923 |
Second Address | Covina, CA 91723-1923 |
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 |