Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1821269887 |
---|---|
Provider Name | Ehteshamul Haque |
First Address | Columbus, GA 31904-5296 |
Second Address | Columbus, GA 31904-5296 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2008 |
Last Update Date | 15/04/2009 |