NPI | 1619961224 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 130193) |
Additional Taxonomies | 173000000X Legal Medicine (Licence: NY 130193) |
Enumeration Date | 2005-09-09 |
Last Update Date | 2013-02-12 |