| NPI | 1124472782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: CA A160959) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: NY 299752) |
| 207R00000X Internal Medicine (Licence: CT 68276) | |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2026-05-05 |