NPI | 1912081845 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 197216) |
Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: NY 197216) |
207R00000X Internal Medicine (Licence: NY 197216) | |
Enumeration Date | 2006-10-25 |
Last Update Date | 2007-12-24 |