Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | PT292668 | CA |
NPI | 1053831594 |
---|---|
Provider Name | Brian Knutson |
First Address | Bakersfield, CA 93312-5688 |
Second Address | Bakersfield, CA 93306-2704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2017 |
Last Update Date | 26/06/2017 |