Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | 313312 | NY |
NPI | 1013470988 |
---|---|
Provider Name | Dr. Brandon Michael Wilkinson |
First Address | Liverpool, NY 13088-4337 |
Second Address | Syracuse, NY 13210-2306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2019 |
Last Update Date | 03/01/2022 |