| NPI | 1003808601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: TX F2434) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX F2434) |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2022-07-19 |