Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 54071 | CA |
NPI | 1427117803 |
---|---|
Provider Name | Paul A Walker |
First Address | Nipomo, CA 93444-9123 |
Second Address | Nipomo, CA 93444-9123 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 25/07/2007 |