Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | ME104948 | FL |
NPI | 1073780052 |
---|---|
Provider Name | Vitaly Siomin |
First Address | Miami, FL 33173-3286 |
Second Address | Miami, FL 33176-2118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2008 |
Last Update Date | 30/01/2022 |