Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 295445 | CA |
Y | 213ES0000X | Sports Medicine | 295445 | CA |
NPI | 1538719521 |
---|---|
Provider Name | Kyle Watry |
First Address | San Francisco, CA 94103-5032 |
Second Address | San Francisco, CA 94103-5032 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2019 |
Last Update Date | 12/09/2019 |