Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 0101031766 | VA |
NPI | 1043239122 |
---|---|
Provider Name | Mr. Manfred Munters |
First Address | Alexandria, VA 22309-2730 |
Second Address | Alexandria, VA 22306-3403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B93659 | (02) | VA |