| NPI | 1679780563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME109991) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT186860) |
| 207R00000X Internal Medicine (Licence: PA MD434699) | |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: PA MT186860) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2020-10-13 |