| NPI | 1689081119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME161980) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD461310) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: NM MD2022-0230) | |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2023-08-15 |