Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | MD174854 | OR |
N | 207SG0201X | Clinical Genetics (M.D.) | P1153 | TX |
NPI | 1700025681 |
---|---|
Provider Name | Wojciech Krzysztof Wiszniewski |
First Address | Portland, OR 97239-3011 |
Second Address | Portland, OR 97239-3011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2009 |
Last Update Date | 02/05/2018 |