| NPI | 1215712443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: KY FL074) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: KY pending) |
| Enumeration Date | 2023-08-28 |
| Last Update Date | 2023-10-17 |