Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1508324369 |
---|---|
Provider Name | Daniel Joseph Stoneback |
First Address | Richmond, VA 23249-4915 |
Second Address | Richmond, VA 23249-4915 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2019 |
Last Update Date | 11/03/2019 |