Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225700000X | Massage Therapist | NVMT.6268 | NV |
N | 226300000X | Kinesiotherapist | NVMT.6268 | NV |
NPI | 1093285850 |
---|---|
Provider Name | Brandon James Borom |
First Address | Sparks, NV 89434-7933 |
Second Address | Sparks, NV 89434-7933 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2018 |
Last Update Date | 11/02/2021 |