Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | PO000227 | PA |
NPI | 1235665498 |
---|---|
Provider Name | Brian Smith |
First Address | Pittsburgh, PA 15228 |
Second Address | Pittsburgh, PA 15228-2419 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2017 |
Last Update Date | 10/05/2017 |