Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 0102201326 | VA |
NPI | 1477633832 |
---|---|
Provider Name | Dr. Per Gunnar Brolinson |
First Address | Radford, VA 24143-1572 |
Second Address | Blacksburg, VA 24060-6685 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 08/07/2007 |