NPI | 1821250192 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208600000X Surgery (Licence: NY 242468) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 242468-1) |
Enumeration Date | 2008-06-27 |
Last Update Date | 2014-01-23 |