| NPI | 1457306318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: VA 0101043875) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101043875) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2022-08-09 |