Individual
BRIAN BAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5 KENMONT DR, CAMILLUS, NY 13031-1511
(315) 751-4091
Mailing address
5 KENMONT DR, CAMILLUS, NY 13031-1511
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
279811
NY
Other
Enumeration date
09/20/2010
Last updated
09/20/2010
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