Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | 35900 | MN |
NPI | 1871024042 |
---|---|
Provider Name | Timothy Behrens |
First Address | Fox Point, WI 53217-3659 |
Second Address | Fox Point, WI 53217-3659 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2017 |
Last Update Date | 21/03/2017 |