Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1043647647 |
---|---|
Provider Name | Evert Michael Dulude |
First Address | Sun Valley, NV 89433-6686 |
Second Address | Sun Valley, NV 89433-6686 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2013 |
Last Update Date | 27/09/2013 |