| NPI | 1598907115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: OK 32073) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 44978) |
| Enumeration Date | 2009-03-27 |
| Last Update Date | 2016-07-27 |