| NPI | 1659653723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME173700) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: ME MD20859) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: VT 042.0017587) | |
| Enumeration Date | 2011-09-15 |
| Last Update Date | 2025-09-15 |