| NPI | 1194700294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: OR MD22223) |
| Additional Taxonomies | 207RG0100X Internal Medicine Gastroenterology (Licence: MT 40698) |
| Enumeration Date | 2005-12-12 |
| Last Update Date | 2022-07-21 |