Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1053699322 |
---|---|
Provider Name | Donald Larkin |
First Address | Las Vegas, NV 89119-4687 |
Second Address | Las Vegas, NV 89119-6191 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2011 |
Last Update Date | 01/02/2013 |