Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | VA |
NPI | 1538254081 |
---|---|
Provider Name | Kent Wright Peterson |
First Address | Charlottesville, VA 22903-4491 |
Second Address | Charlottesville, VA 22903-4491 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |