| NPI | 1215165600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: CA A128757) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A128757) |
| Enumeration Date | 2009-06-24 |
| Last Update Date | 2021-05-19 |