| NPI | 1558365502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: ME MD22051) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME39291) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: MN 68097) | |
| Enumeration Date | 2005-06-08 |
| Last Update Date | 2024-10-29 |