Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1396254306 |
---|---|
Provider Name | Steven Gotfredson |
First Address | Milwaukie, OR 97222-5342 |
Second Address | Milwaukie, OR 97222-5342 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2017 |
Last Update Date | 21/09/2017 |