Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1053663450 |
---|---|
Provider Name | Terrance Alfonso Williams JR. |
First Address | North Las Vegas, NV 89032-7943 |
Second Address | North Las Vegas, NV 89032-7943 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2012 |
Last Update Date | 09/10/2012 |