Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 2616 | CO |
NPI | 1962594978 |
---|---|
Provider Name | Morihiko Wakita |
First Address | Fort Collins, CO 80526-2000 |
Second Address | Fort Collins, CO 80526-2000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 09/07/2007 |