| NPI | 1619348430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: NY 315566) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 63280) |
| 363AM0700X Physician Assistant, Medical (Licence: NY 315566) | |
| Enumeration Date | 2015-10-20 |
| Last Update Date | 2024-01-30 |