| NPI | 1174714067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: CA 20A18363) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101017474) |
| 207R00000X Internal Medicine (Licence: WA OP60345419) | |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: PA OS015147) | |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: WA OP60345419) | |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2021-03-18 |