Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1003939018 |
---|---|
Provider Name | Mr. Keith Alan Winckler |
First Address | Lake Hughes, CA 93532 |
Second Address | Lancaster, CA 93535 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 08/07/2007 |