| NPI | 1962079418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL PA9114729) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2021-06-04 |
| Last Update Date | 2025-07-03 |