Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | MD12707 | RI |
NPI | 1447413505 |
---|---|
Provider Name | Dr. Kyle Joseph Wohlrab |
First Address | Providence, RI 02905-2401 |
Second Address | Providence, RI 02905-2401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2008 |
Last Update Date | 18/12/2017 |