Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 2375 | NV |
NPI | 1073543252 |
---|---|
Provider Name | Dr. Michael J Walker |
First Address | Henderson, NV 89014-3718 |
Second Address | Las Vegas, NV 89119-6171 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 08/07/2007 |