Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner | 1145-39 | WI |
NPI | 1013396472 |
---|---|
Provider Name | Mr. Andrew Braun |
First Address | Appleton, WI 54915-1367 |
Second Address | Appleton, WI 54915-1367 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2015 |
Last Update Date | 19/05/2015 |