Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | PT31528 | FL |
Y | 213ES0000X | Sports Medicine | PT31528 | FL |
NPI | 1114451655 |
---|---|
Provider Name | Robertson Auguste |
First Address | Plantation, FL 33324-2754 |
Second Address | Plantation, FL 33324-2754 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2017 |
Last Update Date | 11/04/2017 |