Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 260092-1 | NY |
NPI | 1003107285 |
---|---|
Provider Name | Gabriel E Yacob |
First Address | North Tonawanda, NY 14120-2019 |
Second Address | Olean, NY 14760-1513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2011 |
Last Update Date | 29/04/2013 |