Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | 10065 | TX |
NPI | 1851377626 |
---|---|
Provider Name | Barry Raborn |
First Address | Houston, TX 77030-4509 |
Second Address | Houston, TX 77054-5000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2005 |
Last Update Date | 09/12/2008 |