Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | 4445 | TX |
NPI | 1043861784 |
---|---|
Provider Name | Mark Anthony Buyo |
First Address | Richardson, TX 75080-1566 |
Second Address | Richardson, TX 75080-1566 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2019 |
Last Update Date | 24/09/2019 |