Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 1522 | TX |
NPI | 1073881348 |
---|---|
Provider Name | Mr. Bryan T Sparks |
First Address | Houston, TX 77054-4101 |
Second Address | Houston, TX 77054-4101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2011 |
Last Update Date | 24/05/2013 |