Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | MI | |
Y | 213ES0000X | Sports Medicine | MI |
NPI | 1043360720 |
---|---|
Provider Name | Mr. Matthew S Woodruff |
First Address | Howell, MI 48855-6410 |
Second Address | Howell, MI 48855-6410 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2007 |
Last Update Date | 08/07/2007 |