Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 179 | OH |
NPI | 1174793517 |
---|---|
Provider Name | Karl Patrick Burk |
First Address | Greenville, OH 45331-2454 |
Second Address | Troy, OH 45373-2304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/02/2008 |
Last Update Date | 29/11/2011 |