| NPI | 1770019069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CT 67614) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA MD-47261) |
| 2085N0904X Radiology, Nuclear Radiology (Licence: IA MD-47261) | |
| 208D00000X General Practice (Licence: IA MD-47261) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 68730) | |
| Enumeration Date | 2017-05-04 |
| Last Update Date | 2022-12-03 |