Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 807 | HI |
NPI | 1003956905 |
---|---|
Provider Name | Robert Canonico |
First Address | Canton, OH 44718-2545 |
Second Address | Aiea, HI 96701-4713 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
208705 | (05) | HI |
G24191 | (02) |