| NPI | 1609214618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: PR 19899) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| 281P00000X Chronic Disease Hospital (Licence: PR 32780) | |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2019-07-16 |