Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 37281 | TX |
NPI | 1063082501 |
---|---|
Provider Name | Marrium Haroon |
First Address | Woodbridge, NJ 07095-1529 |
Second Address | Richardson, TX 75081-5477 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2021 |
Last Update Date | 28/06/2021 |