| NPI | 1801193701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME138174) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: NY 262848) |
| Enumeration Date | 2011-02-12 |
| Last Update Date | 2021-05-05 |