Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | C1-0009299 | DE |
N | 207T00000X | Neurosurgeon | D0073434 | MD |
NPI | 1083620942 |
---|---|
Provider Name | Paul T Boulos |
First Address | Newark, DE 19713-4221 |
Second Address | Newark, DE 19713-4221 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 20/03/2017 |