Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 2001-00261 | NC |
NPI | 1205105053 |
---|---|
Provider Name | Bohdan Malyk |
First Address | Wilmington, NC 28405-4224 |
Second Address | Wilmington, NC 28405-4224 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2011 |
Last Update Date | 19/05/2014 |