Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003219288 |
---|---|
Provider Name | Mr. Roman King Flintroy |
First Address | San Francisco, CA 94103-2911 |
Second Address | San Francisco, CA 94103-2911 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2014 |
Last Update Date | 13/04/2018 |