| NPI | 1467411702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: CA C53475) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301071757) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2021-03-04 |