Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0105X | Surgery of the Hand | G19659 | CA |
NPI | 1730410747 |
---|---|
Provider Name | Mark Slonim |
First Address | La Jolla, CA 92037-7167 |
Second Address | La Jolla, CA 92037-7167 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2010 |
Last Update Date | 15/01/2010 |