Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1942725585 |
---|---|
Provider Name | Mahmood Syed Ghori |
First Address | San Antonio, TX 78205-1912 |
Second Address | San Antonio, TX 78205-1912 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2017 |
Last Update Date | 04/08/2017 |