Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 1574 | ME |
NPI | 1356333686 |
---|---|
Provider Name | Dr. Keelyn Wu |
First Address | Falmouth, ME 04105-1398 |
Second Address | Falmouth, ME 04105-1398 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2005 |
Last Update Date | 28/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G56667 | (02) |