| NPI | 1255594537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: WI 55885) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: KY 03095) |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2021-01-05 |