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Individual
SEDRIC CASUPANG
Active
Individual
SEDRIC CASUPANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
031206-1
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
031206-1
LICENSE NUMBER
NY
Enumeration date
01/15/2010
Last updated
11/28/2011
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