| NPI | 1174765622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: TX Q9843) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: NY 257844-1) |
| Enumeration Date | 2009-03-30 |
| Last Update Date | 2019-08-05 |