NPI | 1215221684 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: NY 273851) |
Additional Taxonomies | 208600000X Surgery (Licence: SC MMD.33588 LL) |
Enumeration Date | 2011-06-02 |
Last Update Date | 2021-11-19 |