| NPI | 1023119138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: PA MD476546) |
| Additional Taxonomies | 207RG0100X Internal Medicine Gastroenterology (Licence: OR MD153344) |
| 207RG0100X Internal Medicine Gastroenterology (Licence: NV 8160) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2022-05-09 |