| NPI | 1861842601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME160149) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: PA MD478573) |
| 207R00000X Internal Medicine (Licence: PA MD478573) | |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2023-07-21 |