| NPI | 1366594749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: AZ 42987) |
| Additional Taxonomies | 207RG0100X Internal Medicine Gastroenterology (Licence: MO 2008024820) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2021-09-13 |