Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1497131619 |
---|---|
Provider Name | Mr. Michael Polomik |
First Address | Cary, NC 27513-4833 |
Second Address | Apex, NC 27502-3955 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2015 |
Last Update Date | 22/11/2016 |