| NPI | 1447868369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: TX BP10084456) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT220595) |
| Enumeration Date | 2020-07-16 |
| Last Update Date | 2023-06-15 |