Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1255659694 |
---|---|
Provider Name | Mr. Michael Jeffrey Altice |
First Address | Wake Forest, NC 27587-4144 |
Second Address | Raleigh, NC 27603-1170 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2010 |
Last Update Date | 10/05/2010 |