| NPI | 1598102626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: CT 62992) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP02857) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: MA 266730) | |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2019-05-31 |