Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 7120104 | NH |
NPI | 1619982329 |
---|---|
Provider Name | Dr. Robert S League |
First Address | Keene, NH 03431-1770 |
Second Address | Keene, NH 03431-3944 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2006 |
Last Update Date | 31/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V11408 | (02) | NH |