NPI | 1508205279 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL M125784) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 302266) |
Enumeration Date | 2013-06-17 |
Last Update Date | 2025-01-15 |