Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | PO000211 | PA |
NPI | 1386185395 |
---|---|
Provider Name | Mr. Steven Lattanzi |
First Address | Abingdon, MD 21009-1204 |
Second Address | Abingdon, MD 21009-1204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2017 |
Last Update Date | 10/03/2017 |