| NPI | 1891105565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: CA A172105) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 56319) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: AZ 56319) | |
| Enumeration Date | 2014-05-05 |
| Last Update Date | 2025-06-20 |