| NPI | 1619263399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: RI MD16090) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI MD16090) |
| 207R00000X Internal Medicine (Licence: RI LP02295) | |
| 207R00000X Internal Medicine (Licence: MA 261952) | |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2018-08-08 |