| NPI | 1114362860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: NC 2016-00904) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 191589) |
| Enumeration Date | 2013-05-08 |
| Last Update Date | 2022-03-10 |