| NPI | 1104232537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: MN 59607) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: WI 69962) |
| 207R00000X Internal Medicine (Licence: MN 59607) | |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2020-08-06 |