NPI | 1235323171 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: NY 245865) |
Additional Taxonomies | 208000000X Pediatrics (Licence: NY 245865) |
2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: NY 245865) | |
Enumeration Date | 2007-09-04 |
Last Update Date | 2007-09-04 |