| NPI | 1265162291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: MA 3018049) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT226639) |
| Enumeration Date | 2022-06-13 |
| Last Update Date | 2025-06-30 |