| NPI | 1427311851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: VA 0101255026) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101255026) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2025-08-28 |