| NPI | 1407904493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 7816) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 21984) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: SC 7816) | |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2020-03-11 |