Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1326346289 |
---|---|
Provider Name | Mr. Matthias J Hall |
First Address | Virginia Beach, VA 23462-6529 |
Second Address | Virginia Beach, VA 23462-6529 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2011 |
Last Update Date | 02/03/2011 |