Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1306334792 |
---|---|
Provider Name | Mr. Matthew Earl Glover |
First Address | Charlotte, NC 28273-4260 |
Second Address | Charlotte, NC 28273-4260 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2018 |
Last Update Date | 01/05/2018 |