| NPI | 1508028143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: NC 2020-03042) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT193973) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: NY 274934) | |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2022-12-28 |