Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | CFO05241 | NC |
NPI | 1700470531 |
---|---|
Provider Name | Patrick Houston |
First Address | Wilson, NC 27893-8611 |
Second Address | Wilson, NC 27893-8611 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2021 |
Last Update Date | 23/02/2021 |