Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 2015-00180 | NC |
NPI | 1003923814 |
---|---|
Provider Name | Evan Ryan Restelli |
First Address | Charlotte, NC 28289-6206 |
Second Address | Pollocksville, NC 28573-8200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 17/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I11858 | (02) | PA |