NPI | 1811060833 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 133408) |
Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NY 133408) |
Enumeration Date | 2006-11-16 |
Last Update Date | 2007-07-08 |