Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist |
NPI | 1093064214 |
---|---|
Provider Name | Qiulu Pan |
First Address | Chantilly, VA 20151-2228 |
Second Address | Chantilly, VA 20151-2228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2012 |
Last Update Date | 04/09/2012 |