NPI | 1487762969 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 164030) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 032750) |
Enumeration Date | 2006-08-26 |
Last Update Date | 2016-11-18 |