Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 408 | CT |
NPI | 1083087159 |
---|---|
Provider Name | Paul Wilhelm |
First Address | Norwalk, CT 06851-1126 |
Second Address | Norwalk, CT 06851-1126 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2015 |
Last Update Date | 11/11/2015 |