Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1326629106 |
---|---|
Provider Name | Gary Dossantos |
First Address | Burien, WA 98148-1111 |
Second Address | Burien, WA 98148-1111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2021 |
Last Update Date | 11/05/2021 |