| NPI | 1366747222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: WA MD60911115) |
| Additional Taxonomies | 207RG0100X Internal Medicine Gastroenterology (Licence: WV 25642) |
| Enumeration Date | 2011-01-24 |
| Last Update Date | 2018-11-21 |