NPI | 1871512574 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 180953) |
Additional Taxonomies | 208000000X Pediatrics (Licence: NY 180953) |
Enumeration Date | 2006-07-19 |
Last Update Date | 2014-08-12 |