Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | CP004024 | TN |
NPI | 1336624469 |
---|---|
Provider Name | Joseph William Raub |
First Address | Wichita, KS 67218-1607 |
Second Address | Wichita, KS 67218-1607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2018 |
Last Update Date | 25/09/2018 |