Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 9694 | TX |
NPI | 1649383233 |
---|---|
Provider Name | Robert Brady |
First Address | Plano, TX 75075-4418 |
Second Address | Plano, TX 75075-4418 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 27/03/2008 |