Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1104249838 |
---|---|
Provider Name | Thomas Herman |
First Address | San Francisco, CA 94117-2209 |
Second Address | San Francisco, CA 94117-2209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2014 |
Last Update Date | 10/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3889 | ABC (01) | CA |