| NPI | 1760878060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: PA MD477400) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: NY 293176) |
| Enumeration Date | 2015-04-13 |
| Last Update Date | 2022-12-20 |