| NPI | 1265084339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: TX V8367) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 8489) |
| Enumeration Date | 2019-07-09 |
| Last Update Date | 2025-06-16 |