| NPI | 1073778064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 46888) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD443519) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: AZ 46888) | |
| Enumeration Date | 2008-07-19 |
| Last Update Date | 2022-10-31 |