Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 74006-20 | WI |
NPI | 1194227504 |
---|---|
Provider Name | Josiah David Magnusson |
First Address | Iron River, MI 49935-8602 |
Second Address | Bronx, NY 10468-3904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2018 |
Last Update Date | 01/09/2020 |