NPI | 1508249459 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 0295533) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT016573) |
Enumeration Date | 2015-07-09 |
Last Update Date | 2021-03-24 |