Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 12669-20 | WI |
NPI | 1144555178 |
---|---|
Provider Name | Dr. Katsumi Neeno |
First Address | Janesville, WI 53545-0723 |
Second Address | Janesville, WI 53545-0723 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2009 |
Last Update Date | 08/10/2009 |