NPI | 1467658153 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NY 265835) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 003117) |
390200000X Student in an Organized Health Care Education/Training Program | |
207Q00000X Family Medicine (Licence: NY 265835) | |
Enumeration Date | 2007-06-21 |
Last Update Date | 2013-03-29 |