Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | ME118640 | FL |
NPI | 1013238344 |
---|---|
Provider Name | Nathaniel Matthew Bolli |
First Address | Clearwater, FL 33764-6576 |
Second Address | Clearwater, FL 33764-6576 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2010 |
Last Update Date | 17/07/2014 |