| NPI | 1336529817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME179835) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME132911) |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2026-08-25 |