| NPI | 1457667602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: WV 29610) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: GA 077752) |
| Enumeration Date | 2010-08-25 |
| Last Update Date | 2023-08-31 |