Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DN22559 | FL |
NPI | 1003344698 |
---|---|
Provider Name | George M Jusu |
First Address | Tallahassee, FL 32308 |
Second Address | Tallahassee, FL 32308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2017 |
Last Update Date | 26/05/2017 |