NPI | 1497311583 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 71905) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT CSP.0080998) |
Enumeration Date | 2019-05-14 |
Last Update Date | 2022-07-28 |