| NPI | 1770074510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME179126) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 312210) |
| 207R00000X Internal Medicine (Licence: NY 312210) | |
| Enumeration Date | 2018-05-29 |
| Last Update Date | 2026-08-28 |