Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 5001178 | WI |
NPI | 1093930380 |
---|---|
Provider Name | Dr. Richard V. Knoff |
First Address | Waukesha, WI 53189-9095 |
Second Address | Wauwatosa, WI 53226-1309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 08/07/2007 |