NPI | 1679639686 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: NC 2025-00223) |
Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: NY 116223) |
207R00000X Internal Medicine (Licence: CA G137486) | |
Enumeration Date | 2006-12-28 |
Last Update Date | 2025-09-19 |