Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | C15405 | MD |
NPI | 1932306511 |
---|---|
Provider Name | Robert John Welk JR. |
First Address | Hastings, NE 68901-3028 |
Second Address | Hastings, NE 68901-3200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2007 |
Last Update Date | 08/07/2007 |