| NPI | 1871283267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX V3227) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: TX V3227) |
| Enumeration Date | 2023-05-10 |
| Last Update Date | 2026-05-21 |