Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 1982-226 | WI |
NPI | 1003247420 |
---|---|
Provider Name | Mr. Robert Donald Wurth |
First Address | Wausau, WI 54403-6214 |
Second Address | Wausau, WI 54403-6214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2013 |
Last Update Date | 11/12/2013 |