| NPI | 1316922511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: FL ME101782) |
| Additional Taxonomies | 207RG0100X Internal Medicine Gastroenterology (Licence: PA MD068281L) |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2024-09-12 |