Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1023352663 |
---|---|
Provider Name | Mr. Shaun Earl Keanulii Vidinhar |
First Address | Las Vegas, NV 89101-2407 |
Second Address | Las Vegas, NV 89101-2407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2012 |
Last Update Date | 20/11/2012 |