| NPI | 1689169591 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: MI 1689169591) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.072046) | 
| 207R00000X Internal Medicine (Licence: IL 036155770) | |
| Enumeration Date | 2018-06-25 | 
| Last Update Date | 2025-06-23 |