| NPI | 1558322917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: KY 32151) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY 32151) |
| 174400000X Specialist (Licence: KY 32151) | |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2021-01-21 |