Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 9440 | TX |
NPI | 1629135504 |
---|---|
Provider Name | Ky Hehl Carlson |
First Address | Conroe, TX 77384-3817 |
Second Address | Conroe, TX 77384-3817 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 08/07/2007 |