Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | MT206032 | PA |
NPI | 1306257878 |
---|---|
Provider Name | Selasie Goka |
First Address | Wilmington, DE 19803 |
Second Address | Philadelphia, PA 19104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2014 |
Last Update Date | 06/06/2017 |