| NPI | 1093375768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: KY 60652) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT217682) |
| Enumeration Date | 2019-06-16 |
| Last Update Date | 2025-08-12 |