Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | MD427693 | PA |
Y | 2084N0600X | Clinical Neurophysiologist | 35.129825 | OH |
NPI | 1073685376 |
---|---|
Provider Name | Miguel Ernesto Habeych Sanmiguel |
First Address | Dayton, OH 45404-1815 |
Second Address | Dayton, OH 45404-1815 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 28/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2623432 | (05) | OH |