Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1215315593 |
---|---|
Provider Name | Mr. Michael Maki |
First Address | Taylor, TX 76574-1214 |
Second Address | Taylor, TX 76574-1214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2015 |
Last Update Date | 07/05/2015 |