NPI | 1477546141 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 099087-1) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 099087) |
Enumeration Date | 2005-08-26 |
Last Update Date | 2010-12-23 |