Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DS026615L | PA |
NPI | 1376717298 |
---|---|
Provider Name | Victor Adrian Alos-Rullan |
First Address | Garnet Valley, PA 19061-1233 |
Second Address | Garnet Valley, PA 19061-1233 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2008 |
Last Update Date | 22/04/2008 |