Provider Information for 1790839769
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MICHAEL JOHN WOULAS phd
Sex: Male
NPI: 1790839769
Last Updated: 2007-07-09
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
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| NPI | 1790839769 | ||||||||||||
| Enumeration Date | 2007-01-23 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 8870 TERRENE CT #102 BONITA SPRINGS, FL 34135-9524 United States Phone: 239-949-2415 | Fax:239-390-1327 | ||||||||||||
| Primary Practice Address | 8870 TERRENE CT #102 BONITA SPRINGS, FL 34135-9524 United States Phone: 239-949-2415 | Fax:239-390-1327 | ||||||||||||
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