| NPI | 1720427974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: ID 2271091) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: UT 12137545-1205) |
| 208D00000X General Practice (Licence: MO 2015013524) | |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2026-01-09 |