| NPI | 1003310152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 76115) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0092899) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: MD D0092899) | |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2025-04-30 |