Individual
JACOB ETHAN NEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4108 PARK RD STE 205, CHARLOTTE, NC 28209-2260
(704) 248-7557
Mailing address
629 RANDON TER FL 32746, LAKE MARY, FL 32746-2636
(321) 626-8947
Taxonomy
Speciality
Code
Description
License number
State
156F00000X
Technician/Technologist
Primary
—
—
Other
Enumeration date
01/25/2024
Last updated
01/25/2024
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