| NPI | 1861137150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: AZ R79490) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R79490) |
| Enumeration Date | 2022-05-01 |
| Last Update Date | 2025-07-24 |