Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 59969-20 | WI |
NPI | 1013184654 |
---|---|
Provider Name | Juan Pablo Rossini |
First Address | Gallup, NM 87305-1337 |
Second Address | Gallup, NM 87301-1337 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2008 |
Last Update Date | 24/03/2014 |