Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1336524081 |
---|---|
Provider Name | Victor Roble |
First Address | Russellville, AR 72811-1463 |
Second Address | Russellville, AR 72802-2206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2015 |
Last Update Date | 23/07/2015 |