Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 2016027860 | MO |
Y | 213ES0000X | Sports Medicine | 2016027860 | MO |
NPI | 1467951715 |
---|---|
Provider Name | Mr. Joshua Nathaniel Little |
First Address | Jefferson City, MO 65109-7906 |
Second Address | Jefferson City, MO 65109-7906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2018 |
Last Update Date | 01/02/2018 |