Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 270638 | NY |
NPI | 1013338052 |
---|---|
Provider Name | Sridhar Nilam |
First Address | Williamsville, NY 14221-8425 |
Second Address | Amherst, NY 14228-2783 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2013 |
Last Update Date | 18/12/2013 |