Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1023391661 |
---|---|
Provider Name | Mr. Scott David Forrester |
First Address | Reno, NV 89502-3542 |
Second Address | Reno, NV 89502-3542 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2011 |
Last Update Date | 20/09/2011 |