Individual
PRABIN THAKURI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AA
Contact information
Practice address
410 S 11TH ST, LAKE WALES, FL 33853-4203
(863) 676-1433
Mailing address
8739 NW 38TH ST APT 228, SUNRISE, FL 33351-1502
(612) 270-9975
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
AA46
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AA46
LICENSE
FL
Enumeration date
10/14/2009
Last updated
10/14/2009
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