NPI | 1164487757 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 152327-1) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD037161E) |
Enumeration Date | 2006-04-18 |
Last Update Date | 2015-06-04 |