| NPI | 1952646507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME167679) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 52577) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: OH 35.131183) | |
| Enumeration Date | 2012-12-10 |
| Last Update Date | 2024-08-29 |