| 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 |