| NPI | 1689174948 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES POTTER Owner 262-825-8984 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: WI 41829) |
| Enumeration Date | 2018-02-13 |
| Last Update Date | 2018-02-13 |