Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | CPO 1456 | DE |
NPI | 1164518114 |
---|---|
Provider Name | Mr. Michael W. Rasch |
First Address | Santa, FE 87505 |
Second Address | Santa Fe, NM 87505-4780 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 11/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
84927054 | (05) | NM |