| NPI | 1306822028 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: MN 41132) | 
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: WI 71899) | 
| 207RG0100X Internal Medicine, Gastroenterology (Licence: AZ 30945) | |
| Enumeration Date | 2005-12-15 | 
| Last Update Date | 2025-10-27 |