Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 926 | HI |
NPI | 1437235710 |
---|---|
Provider Name | Richard Rasmussen |
First Address | Wailuku, HI 96793-6006 |
Second Address | Wailuku, HI 96793-6006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2006 |
Last Update Date | 08/07/2007 |