Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 1301 | LA |
NPI | 1265553127 |
---|---|
Provider Name | Daniel Chistopher Reed |
First Address | Hammond, LA 70403-3854 |
Second Address | Hammond, LA 70403-3854 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 08/07/2007 |