Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1376083402 |
---|---|
Provider Name | Mr. Dennis Farrell |
First Address | Wauwatosa, WI 53226-3431 |
Second Address | Wauwatosa, WI 53226-3431 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2017 |
Last Update Date | 08/03/2017 |