| NPI | 1144604661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: SD 13000) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301108433) |
| Enumeration Date | 2015-07-14 |
| Last Update Date | 2022-03-03 |