Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 056659 | NY |
NPI | 1528444601 |
---|---|
Provider Name | Mohsin Wazir |
First Address | New York, NY 10021-3766 |
Second Address | New York, NY 10021-3766 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2015 |
Last Update Date | 30/07/2015 |