Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | LP. 75 | OH |
NPI | 1457612871 |
---|---|
Provider Name | Mr. Barry W Minor |
First Address | Fayetteville, NC 28314-2563 |
Second Address | Fayetteville, NC 28314-2563 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2012 |
Last Update Date | 01/06/2012 |