| NPI | 1306071725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: SC 40658) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME111605) |
| 207R00000X Internal Medicine (Licence: FL TRN13805) | |
| 207R00000X Internal Medicine (Licence: SC 40658) | |
| Enumeration Date | 2009-05-29 |
| Last Update Date | 2022-07-21 |