NPI | 1801983390 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 276303) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME123689) |
Enumeration Date | 2006-10-06 |
Last Update Date | 2018-05-15 |