Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251E1200X | Ergonomics | 2768-026 | WI |
Y | 225XE1200X | Ergonomics | 2768-026 | WI |
NPI | 1588846497 |
---|---|
Provider Name | Mr. Todd Matthew Andres |
First Address | Green Bay, WI 54304-5568 |
Second Address | Green Bay, WI 54304-5568 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2007 |
Last Update Date | 17/02/2011 |