Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | PTA29000 | FL |
Y | 213ES0000X | Sports Medicine | PTA29000 | FL |
NPI | 1235600354 |
---|---|
Provider Name | Brandon David George |
First Address | Winter Garden, FL 34787-4681 |
Second Address | Orlando, FL 32819-3310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2018 |
Last Update Date | 16/12/2018 |