| NPI | 1538506381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: PA OS019832) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL UO3687) |
| Enumeration Date | 2013-06-03 |
| Last Update Date | 2019-07-01 |