Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 071359 | GA |
NPI | 1043467038 |
---|---|
Provider Name | Gaspar Msangi |
First Address | Marietta, GA 30060-1169 |
Second Address | Marietta, GA 30060-1169 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2008 |
Last Update Date | 17/06/2014 |