Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | MD00032822 | WA |
Y | 2084N0400X | Neurologist | MD00032822 | WA |
NPI | 1245206408 |
---|---|
Provider Name | Roman L Kutsy |
First Address | Everett, WA 98201-2723 |
Second Address | Everett, WA 98201-2723 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 16/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1118462 | (05) | WA |
G10879 | (02) |