Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224P00000X | Prosthetist |
NPI | 1396409181 |
---|---|
Provider Name | Jalal Massenburg |
First Address | Apo, AE 09180-0001 |
Second Address | Thaleischweiler-Froschen, RHINELAND-PALATINATE 66987 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2021 |
Last Update Date | 27/10/2021 |