Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 15234 | CA |
NPI | 1891840500 |
---|---|
Provider Name | Dr. Victor Hennig |
First Address | Redwood City, CA 94061-4093 |
Second Address | Redwood City, CA 94061-4093 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 08/07/2007 |