Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 10460 | MA |
NPI | 1235383183 |
---|---|
Provider Name | George Wu |
First Address | Boston, MA 02118-4804 |
Second Address | Boston, MA 02118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2008 |
Last Update Date | 05/11/2008 |