NPI | 1891042016 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 072624-1) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 072624-01) |
Enumeration Date | 2012-08-07 |
Last Update Date | 2015-05-19 |