Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist |
NPI | 1306044466 |
---|---|
Provider Name | Norman Kruedelbach |
First Address | Fort Myers, FL 33905-7806 |
Second Address | Fort Myers, FL 33905-7806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2007 |
Last Update Date | 10/07/2007 |