| NPI | 1962922708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: CA A199040) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 272094) |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2025-03-07 |