| NPI | 1194796920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2017-02435) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ME MD19527) |
| 207RG0100X Internal Medicine Gastroenterology (Licence: CA A55692) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2025-07-17 |