| NPI | 1255894754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: KY 56789) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 56789) |
| Enumeration Date | 2019-04-11 |
| Last Update Date | 2025-08-05 |