| NPI | 1104810027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: GA 100040) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: TN 36425) |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2024-06-14 |