NPI | 1295939494 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 246551) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 35933) |
Enumeration Date | 2007-06-12 |
Last Update Date | 2024-12-13 |