Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1992950398 |
---|---|
Provider Name | Mr. Robert Joseph Snider |
First Address | Belleville, IL 62221-4067 |
Second Address | Belleville, IL 62221-4067 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2008 |
Last Update Date | 02/11/2010 |