Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | PO000261 | PA |
NPI | 1154099240 |
---|---|
Provider Name | Abiodun Oluwagbenga Sobowale |
First Address | Smyrna, DE 19977-1912 |
Second Address | Philadelphia, PA 19147-4836 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2021 |
Last Update Date | 02/09/2021 |