| 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 |