Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor | C28021214 | CA |
NPI | 1225481427 |
---|---|
Provider Name | Michael Parker |
First Address | San Jose, CA 95110-1713 |
Second Address | San Jose, CA 95110-1713 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2016 |
Last Update Date | 19/03/2018 |