Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | OH000018 | PA |
Y | 222Z00000X | Podiatrist | OH000018 | PA |
NPI | 1043747355 |
---|---|
Provider Name | Mr. Daniel Nathan Wilson |
First Address | Pittsburgh, PA 15238-2908 |
Second Address | Pittsburgh, PA 15238-2908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2017 |
Last Update Date | 17/05/2017 |