| NPI | 1346632643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: WA OP-61480906) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101022082) |
| Enumeration Date | 2015-02-23 |
| Last Update Date | 2025-12-19 |