| NPI | 1053377051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: TX G0520) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: TX G0250) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2021-11-16 |