| NPI | 1225696404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: MI 5101028679) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5151013673APP19) |
| Enumeration Date | 2019-06-03 |
| Last Update Date | 2025-06-03 |