| NPI | 1417174707 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: TX N2900) | 
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: RI LP00546) | 
| Enumeration Date | 2007-04-19 | 
| Last Update Date | 2025-06-25 |