Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1073947826 |
---|---|
Provider Name | Benjamin Chad Walker |
First Address | Winston Salem, NC 27114-4905 |
Second Address | Concord, NC 28025-2965 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2013 |
Last Update Date | 29/08/2013 |