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Individual
MR. KEVIN JEROME FREDERICK
Active
Individual
MR. KEVIN JEROME FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
225400000X
RAHABILITATION PARCTITIONER
CA
Enumeration date
09/25/2013
Last updated
09/25/2013
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