Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | 00203968 | CO |
NPI | 1710345160 |
---|---|
Provider Name | Dr. Paul Wilson |
First Address | Brooklyn, NY 11220-2508 |
Second Address | Brooklyn, NY 11237-4006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2016 |
Last Update Date | 12/06/2019 |