Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | S04016 | MD |
N | 111NN1001X | Nutrition | 2059 | CT |
NPI | 1225577729 |
---|---|
Provider Name | Sean Molloy |
First Address | Glen Burnie, MD 21061-5553 |
Second Address | Glen Burnie, MD 21061-5553 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2017 |
Last Update Date | 27/06/2019 |