Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 02002754A | IN |
NPI | 1013976166 |
---|---|
Provider Name | Dr. Daniel George Wojtusiak |
First Address | Apo, AE 09165 |
Second Address | Apo, AE 09165 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2006 |
Last Update Date | 08/07/2007 |