Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1861630360 |
---|---|
Provider Name | Mr. Charlie Haynes |
First Address | Palo Alto, CA 94304-1207 |
Second Address | Palo Alto, CA 94304-1207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2009 |
Last Update Date | 22/01/2009 |