Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 13154 | NH |
NPI | 1407926819 |
---|---|
Provider Name | Ricardo Andres Gonzales |
First Address | Manchester, NH 03104-4125 |
Second Address | Manchester, NH 03104-4125 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2006 |
Last Update Date | 15/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001490001 | (05) | NH |
I34481 | (02) | MD |