Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1013499417 |
---|---|
Provider Name | Brodie Christian |
First Address | Las Vegas, NV 89130-3446 |
Second Address | Las Vegas, NV 89130-3446 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2018 |
Last Update Date | 31/08/2018 |