Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1295184984 |
---|---|
Provider Name | Malik Muhammad |
First Address | El Paso, TX 79920-5002 |
Second Address | El Paso, TX 79920-5002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2016 |
Last Update Date | 03/06/2016 |