Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1053603639 |
---|---|
Provider Name | Donald White JR. |
First Address | Las Vegas, NV 89146-9066 |
Second Address | Las Vegas, NV 89146-9066 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2011 |
Last Update Date | 21/01/2014 |