Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 0101256874 | VA |
NPI | 1578902565 |
---|---|
Provider Name | Robert Henri Wauters |
First Address | Camp Lejeune, NC 28547 |
Second Address | Camp Lejeune, NC 28547 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2013 |
Last Update Date | 14/01/2022 |