NPI | 1699731588 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 204934-1) |
Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: NY 204934) |
Enumeration Date | 2006-04-21 |
Last Update Date | 2021-12-06 |