Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1245813724 |
---|---|
Provider Name | Michael Bradley |
First Address | Napa, CA 94558-3328 |
Second Address | Napa, CA 94558-3328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2021 |
Last Update Date | 03/05/2021 |