| NPI | 1063480440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME169144) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: OK 20808) |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2024-11-01 |