Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 9610 | SC |
N | 204E00000X | Oral & Maxillofacial Surgeon | 9610 | SC |
NPI | 1487008397 |
---|---|
Provider Name | Habib Asmaro |
First Address | Charlotte, NC 28275-1461 |
Second Address | Charleston, SC 29425-1013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2016 |
Last Update Date | 08/02/2021 |