| NPI | 1790248177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME172124) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R77233) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: FL 34439) | |
| Enumeration Date | 2019-04-11 |
| Last Update Date | 2025-06-26 |