| NPI | 1609138452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: WA 60821860) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10043076) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: MO 2015016238) | |
| Enumeration Date | 2012-06-07 |
| Last Update Date | 2018-09-12 |