Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | A45116 | CA |
NPI | 1013128347 |
---|---|
Provider Name | Lennart Mucke |
First Address | San Francisco, CA 94158-2261 |
Second Address | San Francisco, CA 94110-3518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2007 |
Last Update Date | 08/07/2007 |