Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 2013-01052 | NC |
NPI | 1063739100 |
---|---|
Provider Name | Zachary W Sandbulte |
First Address | Charlotte, NC 28260-0447 |
Second Address | Winston Salem, NC 27106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2010 |
Last Update Date | 25/10/2020 |