| NPI | 1215566955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: ID 2271098) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: CA A185185) |
| Enumeration Date | 2020-04-04 |
| Last Update Date | 2026-07-29 |