Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MT197126 | PA |
NPI | 1003296245 |
---|---|
Provider Name | Salih Grice |
First Address | Latrobe, PA 15650-1197 |
Second Address | Latrobe, PA 15650-1197 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2015 |
Last Update Date | 03/06/2015 |