Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist |
NPI | 1649795063 |
---|---|
Provider Name | Mr. Emad Eldin Ghaly |
First Address | Portland, OR 97230-6708 |
Second Address | Portland, OR 97230 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2017 |
Last Update Date | 07/08/2017 |