NPI | 1659650992 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL uo2883) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 279030) |
Enumeration Date | 2011-08-04 |
Last Update Date | 2021-03-23 |