| NPI | 1700198975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: PA MD449911) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT198061) |
| Enumeration Date | 2010-07-05 |
| Last Update Date | 2025-11-05 |