Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 123672 | NY |
Y | 208600000X | Surgeon | 123672 | NY |
NPI | 1023040045 |
---|---|
Provider Name | Soji Oluwole |
First Address | New York, NY 10035-2709 |
Second Address | New York, NY 10035-2709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E87375 | (02) |