| NPI | 1912132382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: MD D75114) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD486768) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: AZ 49643) | |
| Enumeration Date | 2009-05-28 |
| Last Update Date | 2025-06-06 |