Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | PT-4787 | ID |
Y | 213ES0000X | Sports Medicine | PT-4787 | ID |
NPI | 1205384484 |
---|---|
Provider Name | Dr. Max Esposito |
First Address | Pocatello, ID 83209-0001 |
Second Address | Pocatello, ID 83209-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2016 |
Last Update Date | 15/09/2016 |