NPI | 1578210456 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 315027) |
Additional Taxonomies | 208D00000X General Practice (Licence: NY 315027) |
Enumeration Date | 2022-03-09 |
Last Update Date | 2022-06-06 |