Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 4886 | CA |
NPI | 1043427875 |
---|---|
Provider Name | Mr. Robert John Gomes |
First Address | Eureka, CA 95501-3381 |
Second Address | Eureka, CA 95501-4736 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 08/07/2007 |