Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1386882207 |
---|---|
Provider Name | Mr. Glenn H. Daehnke |
First Address | Medford, NJ 08055 |
Second Address | Medford, NJ 08055-2300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2009 |
Last Update Date | 30/01/2009 |