Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | G44379 | CA |
NPI | 1073519781 |
---|---|
Provider Name | Michael Klair Haseman |
First Address | Sacramento, CA 95815-4227 |
Second Address | Roseville, CA 95661-3831 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2005 |
Last Update Date | 10/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A49628 | (02) |