Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0201X | Pediatric Allergist | G4137 | TX |
NPI | 1992232888 |
---|---|
Provider Name | Subhash Aniruddha Joshi |
First Address | Fort Worth, TX 76133-7903 |
Second Address | Venus, TX 76084-3966 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2017 |
Last Update Date | 22/05/2017 |