Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 1242 | NC |
NPI | 1336697622 |
---|---|
Provider Name | Stuart White |
First Address | Charlotte, NC 28211-2978 |
Second Address | Charlotte, NC 28211-2978 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2016 |
Last Update Date | 14/09/2016 |