Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | LL51987 | SC |
NPI | 1033606660 |
---|---|
Provider Name | Paulo Gonzalez |
First Address | Charleston, SC 29425-6624 |
Second Address | Charleston, SC 29425 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2018 |
Last Update Date | 01/06/2018 |