Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 81853 | MA |
NPI | 1184732406 |
---|---|
Provider Name | Ebrahim Versi |
First Address | Gladstone, NJ 07934-2131 |
Second Address | Eden Prairie, MN 55344-3248 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2006 |
Last Update Date | 08/07/2007 |