| NPI | 1164084653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: SC 93701) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 93701) |
| 207R00000X Internal Medicine (Licence: MA 280891) | |
| Enumeration Date | 2019-07-03 |
| Last Update Date | 2025-08-15 |