Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1306315593 |
---|---|
Provider Name | Kirk Rose |
First Address | Redding, CA 96001-1809 |
Second Address | Redding, CA 96001-1809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2018 |
Last Update Date | 16/11/2018 |