Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 11107 | SC |
Y | 213ES0000X | Sports Medicine | 11107 | SC |
NPI | 1194479717 |
---|---|
Provider Name | William Hendrik Devries |
First Address | Mt Pleasant, SC 29464-7307 |
Second Address | Mt Pleasant, SC 29464-7307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2022 |
Last Update Date | 11/02/2022 |