| NPI | 1255482360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: OR MD161325) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: NM MD2012-0188) |
| 207R00000X Internal Medicine (Licence: UT 6354312-1205) | |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2026-01-13 |