| NPI | 1518152206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: GA 59598) |
| Additional Taxonomies | 208D00000X General Practice (Licence: GA 59598) |
| Enumeration Date | 2007-09-06 |
| Last Update Date | 2022-04-14 |