| NPI | 1235178799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME131748) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: TX L4985) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2022-10-11 |