Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1043646102 |
---|---|
Provider Name | Gernjard Smalls |
First Address | Long Beach, CA 90810-1878 |
Second Address | Long Beach, CA 90810-1878 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2013 |
Last Update Date | 20/09/2013 |