| NPI | 1356765739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: CA A127158) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A127158) |
| Enumeration Date | 2014-02-06 |
| Last Update Date | 2018-11-27 |