NPI | 1750488292 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 229439) |
Additional Taxonomies | 208D00000X General Practice (Licence: NY 229439) |
Enumeration Date | 2006-09-19 |
Last Update Date | 2025-05-01 |