Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 56478 | MA |
NPI | 1316042708 |
---|---|
Provider Name | Brian E Wolf |
First Address | Southbridge, MA 01550-4051 |
Second Address | Southbridge, MA 01550-4051 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 20/12/2011 |