| NPI | 1104357656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: CA A169596) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 64153) |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2022-12-12 |