NPI | 1700147394 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0061255) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 284232) |
Enumeration Date | 2012-05-31 |
Last Update Date | 2019-07-23 |