| NPI | 1255562492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: SC 40149) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: KY 47223) |
| Enumeration Date | 2009-08-05 |
| Last Update Date | 2020-08-21 |