Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 232845 | MA |
Y | 207T00000X | Neurosurgeon | MD440154 | PA |
NPI | 1053508242 |
---|---|
Provider Name | Aubrey S. Okpaku |
First Address | Plymouth, MA 02360-7318 |
Second Address | Plymouth, MA 02360-7318 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2007 |
Last Update Date | 27/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2147793 | (05) | MA |