| NPI | 1366937351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME161580) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 63600) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: MN 63600) | |
| Enumeration Date | 2018-06-22 |
| Last Update Date | 2023-09-01 |