Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 35128918 | OH |
N | 2086X0206X | Surgical Oncologist | MD460397 | PA |
NPI | 1124345905 |
---|---|
Provider Name | Gregory Charles Wilson |
First Address | Cincinnati, OH 45206-1785 |
Second Address | Cincinnati, OH 45219 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2010 |
Last Update Date | 19/06/2019 |