Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter | CFO01950 | VA |
NPI | 1609010685 |
---|---|
Provider Name | Mina Lili Massih |
First Address | Omaha, NE 68114 |
Second Address | Omaha, NE 68114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2009 |
Last Update Date | 22/04/2009 |