| 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 |