Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1174812838 |
---|---|
Provider Name | Steven Grove |
First Address | Greensboro, NC 27405-6965 |
Second Address | Greensboro, NC 27405-6965 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2011 |
Last Update Date | 04/04/2011 |