| NPI | 1568993608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: NC 2021-01332) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 28314) |
| 207R00000X Internal Medicine (Licence: MN 64058) | |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2021-07-06 |