| NPI | 1063488088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 042852) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 042852) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: GA 042852) | |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2021-10-21 |