| NPI | 1104820745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME59839) |
| Additional Taxonomies | 207RG0100X Internal Medicine Gastroenterology (Licence: FL ME59839) |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2022-03-14 |