| NPI | 1629076757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: TX H5014) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX H5014) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2026-02-11 |