Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1336543735 |
---|---|
Provider Name | Ralph Diprospero |
First Address | North Chicago, IL 60064-3048 |
Second Address | North Chicago, IL 60064-3048 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2014 |
Last Update Date | 15/10/2014 |