Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1013291368 |
---|---|
Provider Name | Roland Ewing JR. |
First Address | North Las Vegas, NV 89031-4161 |
Second Address | North Las Vegas, NV 89031-4161 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2011 |
Last Update Date | 05/10/2011 |