Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E1-0010266 | DE |
Y | 222Z00000X | Podiatrist | E1-0010266 | DE |
NPI | 1023545407 |
---|---|
Provider Name | Brandon Arthur Bottini |
First Address | Wilmington, DE 19805-2668 |
Second Address | Vestal, NY 13850-3556 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2017 |
Last Update Date | 09/03/2021 |