Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | A97937 | CA |
NPI | 1437343183 |
---|---|
Provider Name | Mr. Marko Petrovic |
First Address | San Francisco, CA 94116-2761 |
Second Address | San Francisco, CA 94143-0348 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2007 |
Last Update Date | 14/10/2021 |