| NPI | 1154702645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: NE 29677) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 29677) |
| Enumeration Date | 2015-06-10 |
| Last Update Date | 2023-08-03 |