Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | IL | |
Y | 103T00000X | Psychologist | IL |
NPI | 1013986975 |
---|---|
Provider Name | Rudolph Michael Weger |
First Address | Moline, IL 61265-7830 |
Second Address | Moline, IL 61265-7830 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 08/07/2007 |