NPI | 1093040115 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 255828) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25ma08645900) |
Enumeration Date | 2009-10-07 |
Last Update Date | 2010-02-18 |