Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 00995 | GA |
NPI | 1104952035 |
---|---|
Provider Name | Mr. Luis F Paucar |
First Address | St Simons Island, GA 31522-5518 |
Second Address | Brunswick, GA 31520-4722 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00995 | GEORGIA LIENSE (01) | GA |