Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | C2-0010025 | DE |
NPI | 1184751042 |
---|---|
Provider Name | Bradley James Sandella |
First Address | Wilmington, DE 19801-1024 |
Second Address | Wilmington, DE 19803-2763 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2007 |
Last Update Date | 31/08/2015 |