| NPI | 1528051554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: WI 61111-20) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: KY 35838) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: TX M8835) | |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2021-01-18 |