Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 4253 | SD |
NPI | 1013910363 |
---|---|
Provider Name | Thorir Sturla Ragnarsson |
First Address | Dakota Dunes, SD 57049-5312 |
Second Address | Dakota Dunes, SD 57049-5312 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2005 |
Last Update Date | 06/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B85744 | (02) |