Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 1582 | TX |
NPI | 1487044053 |
---|---|
Provider Name | Mr. Dustin Junek |
First Address | Houston, TX 77027-5926 |
Second Address | Houston, TX 77027-5926 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2015 |
Last Update Date | 03/02/2015 |