Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic |
NPI | 1174875983 |
---|---|
Provider Name | Mr. Ndubuisi Mbano |
First Address | Oldsmar, FL 34677-0361 |
Second Address | St Petersburg, FL 33713-8443 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2012 |
Last Update Date | 04/10/2012 |