Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1306275698 |
---|---|
Provider Name | John O'neill JR. |
First Address | Las Vegas, NV 89117-6300 |
Second Address | Las Vegas, NV 89117-6300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2013 |
Last Update Date | 06/11/2013 |