| NPI | 1487912465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: WV 27042) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 48215) |
| Enumeration Date | 2012-04-27 |
| Last Update Date | 2025-09-30 |