| NPI | 1831757145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: GA 111981) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA HS000071L) |
| Enumeration Date | 2019-05-31 |
| Last Update Date | 2026-04-11 |