Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 90793 | NY |
NPI | 1154586295 |
---|---|
Provider Name | Dr. Wilhelm Gustav Hansen |
First Address | Ithaca, NY 14850-2037 |
Second Address | Ithaca, NY 14850-2037 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2008 |
Last Update Date | 28/07/2008 |