Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1285200949 |
---|---|
Provider Name | Mario Hull |
First Address | Pearl, MS 39208-9102 |
Second Address | Pearl, MS 39208-9102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2021 |
Last Update Date | 26/06/2021 |