| NPI | 1255625307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MD D79842) |
| Additional Taxonomies | 207RG0100X Internal Medicine Gastroenterology (Licence: MD D79842) |
| 207RG0100X Internal Medicine Gastroenterology (Licence: OK 38487) | |
| 207RG0100X Internal Medicine Gastroenterology (Licence: VA 0101282073) | |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2025-04-07 |