| NPI | 1780181610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME166987) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036.156356) |
| Enumeration Date | 2018-04-08 |
| Last Update Date | 2025-02-06 |