Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | LO 215 | OH |
Y | 222Z00000X | Podiatrist | LO 215 | OH |
NPI | 1073511804 |
---|---|
Provider Name | Mr. Thomas Michael Wilson |
First Address | Cold Spring, KY 41076-8842 |
Second Address | Cincinnati, OH 45206-2466 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2005 |
Last Update Date | 09/04/2013 |