| NPI | 1265094965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: NM 56664) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NM 56664) |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2019-07-02 |