| NPI | 1114269461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: MD D91249) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: MN 26015) |
| Enumeration Date | 2013-03-25 |
| Last Update Date | 2021-12-13 |