| NPI | 1619139326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: MI 4301106858) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301106858) |
| 207R00000X Internal Medicine (Licence: PA mt193649) | |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2020-05-15 |