| NPI | 1790279842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: VA 0116036188) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2021013944) |
| 208D00000X General Practice (Licence: MO 2021013944) | |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2025-02-27 |