Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1841746385 |
---|---|
Provider Name | Irvin Eugene Thomas |
First Address | Fayetteville, NC 28304-3414 |
Second Address | Fayetteville, NC 28304-3414 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2016 |
Last Update Date | 25/08/2016 |