| NPI | 1053806547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: CA 20A22483) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101024303) |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2024-07-15 |