Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DD4657 | NM |
NPI | 1649631862 |
---|---|
Provider Name | Philip Onyirimba |
First Address | Tierra Amarilla, NM 87575-0250 |
Second Address | Tierra Amarilla, NM 87575 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2016 |
Last Update Date | 02/10/2017 |