| NPI | 1316442601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 202101068) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX V5308) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: TX V5008) | |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2025-06-17 |