| NPI | 1518298728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: ND 13182) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 13182) |
| 207R00000X Internal Medicine (Licence: NC 2010-00014) | |
| Enumeration Date | 2010-01-28 |
| Last Update Date | 2021-04-13 |