Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC006523L | PA |
NPI | 1538493945 |
---|---|
Provider Name | Dr. Thomas B. Wachtmann |
First Address | Fleetwood, PA 19522-8750 |
Second Address | Fleetwood, PA 19522-8750 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2009 |
Last Update Date | 29/01/2011 |