Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1790272482 |
---|---|
Provider Name | Marvin D White |
First Address | Elizabeth City, NC 27909-3361 |
Second Address | Elizabeth City, NC 27909-3361 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2018 |
Last Update Date | 03/04/2020 |