Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | 2015-00802 | NC |
NPI | 1407119266 |
---|---|
Provider Name | Matthew Bruehl |
First Address | Raleigh, NC 27610-1855 |
Second Address | Raleigh, NC 27610 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2012 |
Last Update Date | 07/05/2020 |