| NPI | 1689061830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: OK PENDING) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME131245) |
| 207RG0100X Internal Medicine Gastroenterology (Licence: FL ME131245) | |
| 207R00000X Internal Medicine (Licence: FL TRN21341) | |
| Enumeration Date | 2015-04-24 |
| Last Update Date | 2022-07-05 |