Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1053681031 |
---|---|
Provider Name | Mr. William M Vannah |
First Address | Amherst, MA 01002-1250 |
Second Address | Amherst, MA 01002-1250 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2012 |
Last Update Date | 06/01/2012 |