| NPI | 1063867604 |
|---|---|
| Former Name | ADDISON WALKER |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AR 4643) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 8791) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-05-02 |
| Last Update Date | 2023-08-02 |