Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | MA39650 | FL |
NPI | 1700125556 |
---|---|
Provider Name | Mr. Carl Willard Hall |
First Address | Rockledge, FL 32955-2124 |
Second Address | Rockledge, FL 32955-2124 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2013 |
Last Update Date | 13/02/2013 |