Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | PS00000208 | WA |
NPI | 1104057082 |
---|---|
Provider Name | Mr. Daniel W Samms |
First Address | Tacoma, WA 98405-2308 |
Second Address | Federal Way, WA 98003-8722 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2009 |
Last Update Date | 17/05/2013 |