Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 021065 | VA |
N | 208800000X | Urologist | VA021065 | VA |
NPI | 1063491603 |
---|---|
Provider Name | John W Klousia |
First Address | Alexandria, VA 22306-3171 |
Second Address | Alexandria, VA 22306-3171 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2006 |
Last Update Date | 25/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010273404 | (05) | VA |
F05026 | (02) |