| NPI | 1780209361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: CT 84542) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10070767) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: TX BP20085302) | |
| Enumeration Date | 2020-06-10 |
| Last Update Date | 2026-04-19 |