Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | L5000169369 | FL |
NPI | 1326567959 |
---|---|
Provider Name | Michael Littles |
First Address | Orlando, FL 32806-5455 |
Second Address | Orlando, FL 32806-8549 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2017 |
Last Update Date | 14/09/2017 |