Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | ME81205 | FL |
NPI | 1124249222 |
---|---|
Provider Name | Mr. David A. Nikovits |
First Address | Harrisburg, PA 17104-1677 |
Second Address | Royal Palm Beach, FL 33411 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 20/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H32812 | (02) | FL |