NPI | 1407294408 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: NY 280685) |
Additional Taxonomies | 208D00000X General Practice (Licence: CA 133407) |
Enumeration Date | 2013-06-12 |
Last Update Date | 2015-06-25 |