Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1104425008 |
---|---|
Provider Name | Pawel Brozka |
First Address | Fort Collins, CO 80525-9768 |
Second Address | Fort Collins, CO 80525-9768 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2020 |
Last Update Date | 21/10/2020 |