Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 314160 | NY |
N | 207ND0101X | MOHS-Micrographic Surgeon | 314160 | NY |
NPI | 1053846691 |
---|---|
Provider Name | Paul Joseph Wirth |
First Address | Williamsville, NY 14221-8235 |
Second Address | Orchard Park, NY 14127-1842 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2017 |
Last Update Date | 07/02/2022 |