NPI | 1508851882 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: TX G0712) |
Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: TX G0172) |
207R00000X Internal Medicine (Licence: TX G0712) | |
Enumeration Date | 2005-09-13 |
Last Update Date | 2022-04-20 |