Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | SC520357 | SC |
Y | 213ES0000X | Sports Medicine | SC520357 | SC |
NPI | 1336743475 |
---|---|
Provider Name | Mr. Eli Strom |
First Address | Mount Vernon, WA 98274-9077 |
Second Address | Tigerville, SC 29688-9700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2020 |
Last Update Date | 30/11/2020 |