Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1033477518 |
---|---|
Provider Name | Nicholas Joseph Gomieo |
First Address | Las Vegas, NV 89120-2079 |
Second Address | Las Vegas, NV 89120-2079 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2012 |
Last Update Date | 02/05/2012 |