Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | 201 | NM |
NPI | 1306810205 |
---|---|
Provider Name | Robert Weisz |
First Address | Santa Fe, NM 87501-3784 |
Second Address | Santa Fe, NM 87501-3784 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 08/07/2007 |