| NPI | 1164764320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: MA 284673) |
| Additional Taxonomies | 101Y00000X Counselor |
| 207RG0100X Internal Medicine Gastroenterology (Licence: RI LP03745) | |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2021-02-01 |