Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | S04062 | MD |
NPI | 1114524303 |
---|---|
Provider Name | Takura Abus Tela |
First Address | Rockville, MD 20852-1157 |
Second Address | Rockville, MD 20852-1157 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2020 |
Last Update Date | 01/10/2020 |