NPI | 1114505781 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A197658) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 76080) |
208D00000X General Practice (Licence: CA A197658) | |
208D00000X General Practice (Licence: CT 76080) | |
Enumeration Date | 2021-04-01 |
Last Update Date | 2024-08-17 |