NPI | 1871589556 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: NY 122028) |
Additional Taxonomies | 208000000X Pediatrics (Licence: NY 122028) |
Enumeration Date | 2005-09-27 |
Last Update Date | 2010-06-25 |