| NPI | 1346382082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME147695) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: KY TP016) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: LA 10187R) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2021-08-01 |