| NPI | 1699119321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME126264) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME126264) |
| Enumeration Date | 2013-04-24 |
| Last Update Date | 2026-08-04 |