Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 0006111 | FL |
NPI | 1124233747 |
---|---|
Provider Name | Hal Jay Richman |
First Address | Aventura, FL 33180-1226 |
Second Address | Aventura, FL 33180-1226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T 8573 0 | (02) | FL |