| 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 |