| NPI | 1891275566 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: MA 1023679)  | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP04366)  | 
| 207R00000X Internal Medicine (Licence: RI MD17506)  | |
| Enumeration Date | 2018-08-21 | 
| Last Update Date | 2025-06-19 |