Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 1625 | TX |
NPI | 1184051906 |
---|---|
Provider Name | Mr. David George Wilson |
First Address | Dallas, TX 75390-9091 |
Second Address | Dallas, TX 75390-9091 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2013 |
Last Update Date | 11/10/2013 |