NPI | 1588152789 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 66853) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 66853) |
Enumeration Date | 2018-04-24 |
Last Update Date | 2023-04-28 |