NPI | 1306266952 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 390200000) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 287960) |
Enumeration Date | 2014-04-22 |
Last Update Date | 2018-06-06 |