NPI | 1104014422 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 245840-1) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 245840) |
Enumeration Date | 2007-10-11 |
Last Update Date | 2017-01-12 |