Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1003188582 |
---|---|
Provider Name | Tarik K Blair |
First Address | Altadena, CA 91001 |
Second Address | Altadena, CA 91001-4529 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2012 |
Last Update Date | 31/01/2012 |