NPI | 1780435982 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2085R0001X (Licence: MA 3016406) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 3016406) |
Enumeration Date | 2024-03-27 |
Last Update Date | 2025-07-09 |