| NPI | 1578940359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: MA 275620) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 275620) |
| Enumeration Date | 2015-04-30 |
| Last Update Date | 2023-02-27 |