| NPI | 1558715110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: CA A151164) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: NY 315245) |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2025-07-11 |