Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | CP3095 | MI |
NPI | 1366957946 |
---|---|
Provider Name | David A Keck |
First Address | Kinston, NC 28504-8208 |
Second Address | Kinston, NC 28504-8208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2017 |
Last Update Date | 05/12/2017 |