NPI | 1962465518 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 291913) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS17044) |
Enumeration Date | 2006-04-06 |
Last Update Date | 2024-09-20 |