Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | CHIR008506 | GA |
NPI | 1033340351 |
---|---|
Provider Name | Yoshiro Yajima |
First Address | Doraville, GA 30360-1746 |
Second Address | Doraville, GA 30360-1746 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2009 |
Last Update Date | 18/11/2010 |