Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 138252 | NY |
NPI | 1003819053 |
---|---|
Provider Name | Thomas J Laclair |
First Address | Syracuse, NY 13204-2866 |
Second Address | Camillus, NY 13031-1648 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 12/05/2008 |